Saville Manor Nursing Home

We found the following examples of good practice.

• Staff greeted visitors at the entrance to the home and explained the safety procedures in place. These included provision of personal protective equipment (PPE), such as gloves, aprons, facemasks and overshoe protectors. Visitors were asked to read and sign a health declaration and have their temperature checked on arrival. They were shown to the area of the home they were visiting, by the shortest and most direct route.

• People had been supported to maintain contact with their loved ones, through video and phone calls. People had been supported with regular entertainment, provided from the garden, and with additional activities provided by staff in the home.

• Structured and planned internal and garden visits were facilitated. Most internal visits took place in a communal area that had direct access into the garden. A dividing screen and safety protocols were in place. The implementation of further safety measures was in progress, and a room dividing screen was being fitted, with an intercom to aid communication between people using the service and their loved ones.

• When people were admitted to the home, risk assessments were completed, and people were isolated for 14 days. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

• Regular testing for COVID-19 was being undertaken. Staff were tested weekly, and people using the service were tested monthly.

• Saville Manor had clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received training and regular updates were provided. ‘Covid’ files were available in different languages, for staff to read. The home manager and senior staff completed daily ‘spot checks’ and regular supervisions. These were completed to check staff understanding and compliance with use of PPE and infection prevention and control practices.

• There was regular communication from the directors and area manager to the home manager, staff, people using the service and relatives. The home manager spoke positively of the support they received.

• The home was clean and free from clutter. Housekeeping and laundry practices were overseen by a senior housekeeper, who checked work had been completed to a satisfactory standard and that supporting records were maintained.

Saville Manor is a care home that provides personal and nursing care for up to 42 older people. The service is provided in accommodation over four floors. At the time of the inspection, 34 people were living at the home.

What life is like for people using this service:

People who used the service and relatives spoke positively and told us they felt safe in the home.

Improvements had been made and people received safe care and treatment. Monitoring records were accurate and up to date, Topical creams, fluid thickeners and equipment were used safely.

Quality assurance risks systems identified shortfalls and actions plans were in place to mitigate risks and make improvements.

Staff had received sufficient training to carry out their roles. Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were supported to access health care services and regular visits were undertaken by their GP.

People’s dietary needs were assessed, and people were offered choices at mealtimes. People received the support they needed with food and fluids.

People and relatives were asked for feedback and knew how to complain. No-one was receiving end of life care at the time of our inspection visit.

People received care that was kind and respectful. Care plans were detailed and reviewed each month.

The service met the characteristics of Good in the key questions Safe, Effective, Caring, Responsive and Well-led. and Well-led. Therefore, our overall rating for the service after this inspection has improved to Good.

More information is in detailed findings below.

Rating at last inspection:

Requires Improvement (report published in February 2019 following a focused inspection).

At that inspection, we inspected the safe and well-led domains only.

Prior to the above inspection, at the last comprehensive inspection we rated the service as Good (report published in July 2017).

Why we inspected:

Services rated “requires improvement” are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people receive.

Follow up:

We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

At the last comprehensive inspection in May 2017, the service was rated Good.

We received concerns about the care and treatment of a person who lived in the home and sustained a serious and unexplained injury in October 2018. At the time of our inspection, the police were investigating this incident.

Following the above incident, we carried out a focused inspection. We inspected the key questions: is the service safe? and is the service well-led? This report covers our findings in relation to those two key questions. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saville Manor on our website at www.cqc.org.uk.

There was no registered manager in post. A manager had recently started in post. They had not yet submitted their application to register with the Care Quality Commission. 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.

At this inspection we found the service was not consistently safe. Topical medicines were not always safely managed. Fluid thickening powders were not always stored or used in accordance with current NHS patient safety guidance. Pressure relieving equipment was not always used to provide optimum support and protection. Monitoring records were not always accurately completed to show that people had received sufficient fluids. Equipment such as hot surface temperature radiators were not used safely.

Staff had a good understanding of how to make sure people were supported and protected from the risks of abuse and avoidable harm. They had received safeguarding adults training and knew how to report concerns.

Staff had received moving and handling training and were clear about how to safely support people with walking aids and moving and handling equipment such as hoists.

There was no registered manager in post. A new home manager was in post and was planning to submit an application for registered manager with CQC.

Quality assurance systems did not always identify shortfalls and actions were not always taken when shortfalls had been identified.

At this inspection we found breaches in two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The rating of the service has deteriorated to Requires Improvement in the safe and well-led domain. The overall rating for the service is now Requires Improvement.

There was no registered manager for the service as they had very recently left. There was an acting manager in post. They had worked for the provider for a number of years. They were in the process of applying to be registered with us. 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 safe and CQQ and the Local Authority had been informed of most of the relevant safeguarding concerns. However one recent allegation of poor practice had been dealt with by the provider internally. Action had been taken to keep people safe but the CQC and Local Authority had not been informed of the concern. The provider sent us information after our visit to explain how they had made this decision. However the nature of the concern meant it could be considered to be a safeguarding matter.

We have made a recommendation about staff training to ensure correct safeguarding reporting procedures are followed.

Staff were being supervised by the management and other senior staff. The provider had a clear supervision procedure in place that set out how this process was aimed at developing and supporting staff. However, supervision at the home had regularly been carried out in in a way that could be seen as negative towards the staff members being supervised. This could lead to staff not feeling motivated or valued in their work.

We have made a recommendation around staff supervision so that it is carried out in a way that is beneficial to staff and people at the home.

Risks to the safety and wellbeing of people were reduced because staff had completed safeguarding adults training, and knew how to identify the different types of abuse. Risk assessments were in place that identified the areas where the safety of people may have been at risk. Accidents and incidents were reviewed and actions taken to keep people safe. Trends were also identified to reduce the risk of reoccurrences. There were safe practices and procedures for the management of medicines in the home.

People told us they liked the food and we saw they were offered choices at each mealtime to help them decide what meal they wanted. People at the home and the staff had developed caring relationships. This was also the case with relatives and friends who spoke highly of the caring attitude of the staff.

Staff had an understanding of the needs of the people they supported and knew how to care for them in a way that met their needs. The staff we saw had a caring and attentive manner towards the people they supported who lived at the home. We saw that whenever possible, people were involved in making decisions about their care and support needs. People were offered discrete and sensitive assistance if they needed support to eat their meals or with intimate care.

When people had specific health needs and concerns there were arrangements in place for them to see their GP and other healthcare professionals. Staff closely monitored the health and well-being of people on an on-going basis. People were supported to consume the food and drinks they enjoyed and they were able to choose what they wanted. People were given discrete assistance if they needed support to eat their meals. The staff knew how to support people effectively and in a way that fully met their needs. The team of staff at the home were caring and supportive in manner towards each person they supported.

People had their needs met by a team of properly trained staff. The staff attended frequent training opportunities and were developed in their work. This helped them to improve and develop their skills and competencies. Nurses were supported to go on regular clinical training and updating of their skills. This was to help them to be able to provide nursing care based on best practices.

There was a safe level of suitably qualified staff on duty at any time .The provider had devised their own dependency tool to calculate the numbers of staff required. The tool also helped work out the skill mix of staff that were needed to provide safe care at any time. The numbers of staff had been identified based on how much support and care each person required.

People received care and support that met their individual needs. People were encouraged whenever possible to make their own choices and decisions in relation to their daily life. When people did not have full capacity to make decisions staff understood what to do to ensure that decisions made on behalf of the person were in their best interests. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were able to take part in a wide variety of lively and informal one to one and group activities. The environment was personalised with features that were beneficial for people who lived there. There was a secure garden and comfortable seating areas. There was also a variety of decorative items to make the place more homely.

People and those who represented them were supported to be able to complain and make their views known. The provider actively sought the views of people and their families. Suggestions were acted upon and changes were made to the service when needed. Feedback about the home from people and others involved in their care was used to find out where improvements were needed and how the service could be further improved. There were systems in place to monitor the service to ensure people received care that was safe and met their needs.

The provider and management showed they were committed to improving the service for people at the home. For example, they expected staff to follow their key value of ‘putting life into years’ in the way they cared for and supported people as well as how they aimed to develop the service.

People had positive views of Saville Manor. Examples of comments included, 'if you have to go anywhere then this is the best place to be' and 'it is a very good home and it takes you on and looks after you'.

Peoples were effectively assisted by the staff so that their range of nursing and care needs were met.

The majority of people felt satisfied with the meals that were provided with at the home. A small number of people felt that sometimes the food lacked flavour and was bland.

People were assisted by staff who were supervised to make sure they provided them with suitable care and support. The staff were able to obtain further qualifications and were trained in subjects relevant to peoples' needs.

The quality of care and overall service people received was checked and monitored to make sure it was safe and suitable.