Archived: The Manor House Nursing Home

We walked around the home during both of our visits looking in communal areas and people's bedrooms. The rooms we saw were clean and tidy.

Since our meeting with the provider further concerns about the care provided at the home had been brought to our attention by a member of the public and we considered that an earlier visit was necessary.

We carried out this visit at the same time representatives from the local authority Care Services Quality Team visited the service.

We found that work was still being carried out to review and update the care records for each person who lived in the home and we saw evidence of some of the work that had taken place. It was hoped that when completed there would be improved care plans for each person which detailed their individual needs and preferences and which provided accurate information for staff about the care and support they needed to give to people.

When we spoke to care staff responsible for their completion they told us that the new person centred care plans were nearing completion.

When we visited there was a calm atmosphere in the home and we saw that staff cared for people in a caring and attentive manner. People who used the service were able to choose where they wished to spend their time and we saw that some people were spending time in communal areas and some people had chosen to remain in their rooms.

Since our last visit there had been an increase in the amount of hours made available for recreational activities and an additional activities coordinator had been employed. On the day of our visit both members of staff were on duty and we saw that they encouraged people to join in with group activities such as card games and discussions which took place in communal areas.

People who used the service appeared comfortable and relaxed in their environment. One person we spoke with told us that they preferred to spend time in their room sat out in their armchair. They said they were warm and comfortable and that staff cared for them well.

The home had a call bell system with call bell points in each bedroom to enable people to call for assistance from their room. When we walked round the home we saw that one person's armchair was on the opposite side of the room to the call point and they were unable to reach it if they needed it. When we spoke to some staff we were told that they were aware of the issue and that they had provided an extension lead for the point. This was not being used when we visited. When we looked at the person's care records there was no evidence that the situation had been risk assessed and no care plan was in place to ensure their ongoing safety when alone in their room.

We saw that when the assessments had been completed the care plans had not been put in place to support people's identified needs. One person had been admitted for short term rehabilitation. There were no care plans to show staff how to meet this person's needs and what they needed to do to prepare them for leaving the home. Staff had not received specific training in rehabilitation.

Another person had been identified as needing social interaction. There were no care plans to demonstrate how staff could make this happen. When we spoke to staff they told us they had little time to sit and chat with people. The home had an activities coordinator who worked three days per week but no time had been identified in the care documents to spend time with this person.

When we spoke with staff they told us that they were busy and struggled to meet the care needs of people who lived in the home. They told us that this meant that sometimes they 'cut corners' and things were not always done as they should be. Staff felt that there was a shortage of equipment for moving and handling which caused some delays in meeting people's needs. We were told there was only one large hoist sling which meant that people who lived in the home sometimes had to wait or have to use a smaller sling.

They told us that covering staff sickness was difficult and that if they could not find staff to cover the shifts they worked with reduced numbers and were not always able to get agency staff.

When we walked around the home we saw that it was clean and tidy and we saw staff caring for people who lived in the home in a caring manner and treating them with dignity and respect. The atmosphere within communal lounges was generally calm and relaxed although staff were observed carrying out their duties in a hurried manner.

When we spoke to people who used the service they told us that they were able to choose where and how they wished to spend their time and that they could make decisions about their care but this was not supported in their care documentation.

During our visit we observed the lunchtime routine. We saw that the atmosphere was calm and relaxed and people were beings supported to eat their meals as needed. Tables in the dining room had been laid for lunch and people were offered a choice of cold drinks and fruit juices. People were offered second helpings of food as preferred and we saw that people were having different menu choices as was their preference.

When we visited the home in July and November 2011 we found that several areas in the home were awaiting refurbishment which included bathing and shower facilities on the first and second floor. When we visited this time we found that work had still not been completed.

We did not speak directly to people who use the service about safeguarding from abuse during this visit although the people we did speak to told us that they felt safe in the home.

When we spoke to staff they told us that they would feel confident reporting any concerns or potential abuse to senior staff in the home. When we asked them about the wider safeguarding procedures their knowledge was limited.

When we spoke to staff not all of them felt confident reporting concerns to management. Some staff said concerns about a lack of resources and pressure on staff had been raised to management but they did not always feel they were listened to.

During our visit we observed people sitting in the lounge areas. The television was on in both rooms throughout the day and we saw no evidence of any other activities taking place. The home had a part time activities organiser and at the time of our visit an advertisement had been placed to recruit someone for additional hours.

The home was generally clean and tidy. We saw that some new furniture had been purchased to replace older worn equipment and furnishings. We saw some bedrooms where carpets had been replaced and where profiling beds had been provided.

We saw that people were able to decide where they wished to spend their time, and some people had chosen to remain in their own rooms rather than in the communal areas.

When we walked around the home we saw that people had cold drinks accessible to them throughout the day and at lunchtime jugs of water were placed on each table for people. Soft drinks were also available.

When we walked around the home we saw staff caring for people in a calm and unhurried manner and the atmosphere most of the time was calm and relaxed.

The lunchtime period was different and we saw that staff appeared to be under pressure and had limited time to meet people's needs. We noticed that call bells were not ringing for excessive periods during the morning although there was some delay after lunchtime was over.

We were told that there were normally seven care staff on duty but on the day of our visit due to unforeseen absence there were only five. We were told that no replacements had been found but the senior staff told us they felt the numbers on duty were sufficient to meet the needs of the people in the home on that day.

We found that people were not always consulted about their care and treated with dignity and respect.

During our observations we saw people sat at the table for lunch. We saw one person interrupted by nursing staff to take their blood sugar levels and then later interrupted again during their lunch to have their insulin administered. The person was not asked if they minded this being done in front of other people and their lunch being interrupted.

We saw one person seated in the main lounge during the afternoon. The person had food from the previous meal on their lap and had a table in front of them with their evening meal. It was not clear if this person had moved out of the chair since lunchtime.

We observed the lunchtime routine. On the day of our visit there was an unforeseen shortage of care staff. The atmosphere over the lunchtime period generally felt quite rushed although residents experienced long intervals between courses with no interactions from staff.

There were a lot of interruptions during lunch in the dining room with staff walking through the room repeatedly to access the kitchen and some staff talking to people across the room. In addition to this, music was playing from a radio throughout mealtime. It was not clear if this was the choice of the people using this room.

Plated meals were served to people and we saw that people were given adequate portions. Food was generally well presented. We saw people being given a choice of three deserts.

Some of the people we saw had limited physical ability, which meant that they had to eat their meal one handed. There was no adaptive cutlery or tableware to assist them and we saw people struggling to eat their meals unassisted.

At one table we saw one person attempting to assist another person who they could see was having difficulty. Elsewhere in the room we saw another person had dropped some of their food onto the floor as they were not able to access it easily.

We observed three staff assisting people on two tables to eat their meals. They did so in a very calm and unhurried manner but were very task focused making very little verbal interaction with the people they were helping.

When we watched one person being taken into the dining room we saw them being moved in a wheelchair and the foot plates were not being used. This means this person's feet were not supported and they were at risk of injury or entrapment.

We found that there were very limited opportunities for people to provide feedback about the home, the care given to them and make suggestions for improvements. There was no evidence that any resident meetings had been held since our last visit.

At the time of our visit the service had a manager responsible for the day to day management of the home but the manager was not registered with the Care Quality Commission.

One person said' anything you want they will bring it and you couldn't wish for better'.

One person told us that they sometimes have to wait for help to the toilet. They said staff were lovely towards them but were very busy. Another person said they usually waited between 5-10 minutes for help to the toilet.

We walked around the home and the bedrooms we saw were personalised, pleasant and homely.

Televisions were on in both lounges throughout the day and people's chairs were positioned to face the television in most cases. In one lounge people we spoke to told us that they did not particularly like the television but there was nothing else to do. The home had an activities organiser who was on leave at the time of our visit and a regular programme of activities was scheduled to take place. No provision had been made for any activities in the organisers' absence and engagement with staff was mainly task focused.

The home has a large garden area to the rear of the property with a paved seating area and raised flower beds. The gardens appeared well maintained and were attractive. Some of the people we spoke to told us that they had enjoyed sitting out in the gardens during the recent spell of fine weather.

People we spoke to were satisfied with the meals provided. They told us that they receive plenty to eat and they can have snacks outside of mealtimes if they wish.

We observed the lunchtime meal service. People were able to make a choice about where to eat their lunch but not all of the people had been able to make a choice about what they were having for lunch. We saw that several people needed assistance to eat their meals. Staff supporting people were caring and attentive and we saw some good examples of engagement with people. However, there were periods where people being supported by staff were left as staff went to assist others.

When we spoke to people about bathing and showering we asked if they were able to decide when to have a bath or shower. They told us that when they were admitted to the home staff had offered them a day and time for bathing and they fitted round that suggestion. While it was not their preferred choice of time they were happy to agree with the suggestion. Staff told us that if people request a bath or shower this would be provided and that if people refuse a bath or shower when offered they respect their right to refuse. They said that most people living in the home preferred to have a shower.

One person we spoke to wore glasses they told us that they have regular eyesight checks and staff from the home arrange for the optician to see them at the home. Another person told us that staff had accessed dental care for them when they had experienced problems with their teeth.

One person told us that they had just moved to the home. They told us that they had been made to feel very welcome by staff and were happy with their ground floor accommodation.

We saw staff sat with people who needed support at mealtimes and providing assistance in a calm and caring manner. Staff took meals to people who wanted to have them in their bedrooms

People were being cared for in a calm and caring manner and we observed good relationships and interactions between staff and the people living in the home.