Manor Barn Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of the legal regulation in relation to people’s safe care and treatment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were not always learnt to continually identify and embed good practice. Incidents and accidents were reported and analysed to identify the likely cause of the incident. The registered manager had oversight of this system but there was inconsistent practice with regard to learning from incidents. For example, a care plan noted a person with dementia was sometimes resistant to support with personal care. Unexplained bruising was recorded during monthly reviews on 7 occasions. Accident reports had been completed and analysed by a senior staff member. However, the pattern of bruising and injuries had not been noted or considered under the provider’s safeguarding policy and the care plan had not been updated in response to these incidents.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services.

Initial assessments were completed to determine whether the service could meet people’s needs. This system was not consistent in ensuring that care was provided in a safe way when people moved to the service. Staff did not always have the knowledge, skills and experience to meet people’s individual needs effectively. A person with specific medical needs had moved to the service but staff had not received the training they needed to provide safe care and treatment. The registered manager explained that training was provided as soon as this shortfall was recognised. When a person with learning disabilities moved to the service, the provider’s initial assessment had not given due consideration to the principles of Right Support, Right Care, Right Culture. Staff did not have the training, skills or experience to meet the person’s needs. Following this assessment the provider confirmed they would work with the local authority to review the person’s needs.

The provider did not always share concerns quickly and appropriately. Not all staff were able to demonstrate a clear understanding of their responsibilities to safeguarding people from harm. Some staff described how they needed to keep people safe from physical risks but were not clear about possible indicators of abuse. Other staff were not clear about when they needed to report concerns of potential or suspected abuse. Unwitnessed incidents were recorded but staff did not always consider the provider’s safeguarding policy when analysing incidents and accidents. This meant there was a risk that potential safeguarding incidents were not consistently reported in line with good practice. Following the assessment the registered manager took immediate action to notify the local authority retrospectively about potential safeguarding events to ensure openness and transparency.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems were in place to assess and mitigate risks to people’s health and safety. However, not all risks had been assessed and there were shortfalls in care plans which meant staff did not have all the information they needed to provide safe care. Suction equipment was present in a person’s room. This equipment is used for removing blockages that obstruct a person’s breathing. There was no risk assessment or care plan in place to guide staff in how and when to use this equipment. Some people needed thickening powder to be added to drinks to enable them to swallow liquids safely. We observed that thickening powders were not stored securely. This posed a risk to some people who lived with dementia because thickening powder could cause harm by asphyxiation if swallowed accidentally. We brought this to the attention of the registered manager who took immediate steps to ensure the safe storage of the powder for people’s safety.

We observed staff supporting people safely. Two staff supported a person to move using a hoist and sling. They used a gentle approach, checked with the person first and provided reassurance. Staff appeared confident and the person seemed to be relaxed and comfortable throughout the transfer.

The provider did not always detect and control potential risks in the care environment. Some people who lived with dementia, were able to move around independently and were at risk of falling on the stairs. We observed there were stair gates at the top and bottom of the stairs leading to the first floor. The gate at the top of the stairs had a faulty catch which meant the gate was not secure. Stairs leading to the second floor did not have a stair gate. When we brought this to the attention of staff, they took immediate action to repair the catch on the stair gate. The provider explained there were plans in place to make improvements to the stair ways to make them safe. Following the assessment, an additional stair gate was added for the stairs to the second floor to keep people safe. We observed how some areas of the home had an unpleasant smell and the provider had identified this was due to unclean carpets in some rooms. Since the provider took over the service a refurbishment programme had been started, and staff told us there were plans in place to replace the old carpets.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

There were enough staff on duty to provide safe care to people, however staff did not have the knowledge, skills and experience to meet all people’s individual needs. Staff demonstrated a lack of understanding in meeting the needs of people with a learning disability. Staff had received basic awareness training about people with learning disabilities, one staff member told us they had experience from a previous job, but staff did not demonstrate a consistent understanding of how to assess and meet the needs of people with learning disabilities.

People told us staffing levels were consistent and they had confidence in the staff. One person told us, “I feel safe with them.” Staff told us there were enough staff on duty and described receiving regular training. One staff member told us, “The training I received is very good and helps me do my job well.” Staff received regular supervision and said they felt well supported. One staff member was positive about the supervision they received, they said, “It helps me stay on track and improve.” The provider had robust systems for recruitment to ensure staff were suitable to work with people who required care and support.

The provider had robust systems for recruitment to ensure staff were suitable to work with people who required care and support.

The provider did not always assess and manage the risk of infection. Regular cleaning schedules were in operation, however in some areas of the home the carpets remained unclean and emitted an unpleasant odour. This meant the provider could not be assured risks of infection were being effectively managed. Staff told us there were plans to replace the carpets. Our observations were that other areas of the service were clean and tidy. One staff member described having regular training in infection prevention and control. They told us, “We clean everything every day, all the different surfaces.” Our observations confirmed staff were using appropriate personal protective equipment and supplies were available to staff.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Systems for managing medicines were safe. We observed the staff member who administered medicines knew people well and demonstrated a clear understanding of their needs. They used a gentle approach and supported people in a personalised way. Systems for monitoring medicines were effective and records were accurate.

Some people, who were living with dementia, needed to receive their medicines covertly (without their knowledge). Issues of consent had been considered and documented following good practice to ensure administering medicines in this way was in the person’s best interests