Ealing Manor Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service since registered as a partnership in 2024. This key question has been rated requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulations relating to safe care and treatment (Regulation 12) and good governance (Regulation 17). People's needs, risks and outcomes were not always accurately assessed, recorded or effectively monitored. Care records did not consistently provide staff with clear guidance or demonstrate that professional advice and interventions were effectively incorporated into care planning.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure people's health, care, wellbeing and communication needs were comprehensively and accurately assessed, reviewed and reflected in their care planning.

Assessments and care records contained inconsistent information about people's mobility, moving and handling needs and the level of staff support required. We found conflicting information between care plans, risk assessments, moving and handling records and Personal Emergency Evacuation Plans. For some people, records described different levels of mobility or support requirements. This meant staff did not always have clear and accurate guidance about people's current needs.

This reduced assurance that care was planned and delivered consistently and safely.

Communication needs were not always formally assessed or clearly documented. The service supported people who spoke languages other than English. However, there was limited evidence of structured assessments detailing how information should be provided to meet individual communication needs.

The registered manager told us relatives had provided information to help staff communicate with one person who did not speak English. While this provided some support, the person’s communication needs and preferences were not fully reflected in their assessment and care plan. This meant the provider could not consistently demonstrate how communication needs had been assessed and translated into care planning.

The service supported a number of people living with dementia. Environmental adaptations to support orientation and independence were limited. Apart from coloured doors and room numbers, there was little personalised information available to help people identify their rooms or maintain familiarity with their surroundings. Life history information was not routinely available within people's rooms, which reduced opportunities to provide personalised support based on people's backgrounds, preferences and experiences.

However, pre-admission assessments were completed before people moved into the service. Information was gathered from hospitals, families and healthcare professionals to help identify people's needs. The registered manager told us, "We know everything before the person comes." Staff also described reviewing information from hospitals and community professionals to support people when they moved into the service.

The provider did not always ensure people's care and treatment was planned and delivered in line with their assessed needs, professional guidance and relevant evidence-based practice.

Care records did not always contain sufficient detail to guide staff consistently. We reviewed records relating to PEG feeding, wound care, catheter care, nutrition and pressure area management. We found care plans were often task-focused, difficult to interpret and lacked clear guidance about how care should be delivered.

For example, PEG feeding records did not consistently provide detailed information about feed administration and monitoring. They also lacked clear escalation arrangements or guidance about actions staff should take if complications occurred. Wound care and catheter care records did not always demonstrate how interventions were evaluated or whether care remained effective. Reviews frequently stated care should continue without evaluating outcomes or whether changes were required.

Guidance for staff was not always sufficiently detailed or individualised. Several care plans contained generic interventions and limited information about people's preferences and goals. They also lacked clear guidance about how staff should respond to changes in need. Staff knew people well and could describe how they met their needs, but this information was not consistently reflected in care records. This reduced assurance that care would be delivered consistently by all staff.

People who had difficulty swallowing or were at risk of choking had been assessed by speech and language therapists. Specialist advice was available within care records. However, the kitchen did not have an up-to-date list of people requiring modified diets. Kitchen staff were able to identify people who required modified diets, but the written guidance had not been updated. The chef also did not demonstrate a clear understanding of all International Dysphagia Diet Standardisation Initiative levels. This reduced assurance that professional guidance was consistently translated into practice.

Despite these shortfalls, people had access to specialist healthcare support. Records evidenced involvement from general practitioners, dietitians, tissue viability nurses, physiotherapists, mental health professionals and palliative care teams. Staff sought advice when concerns arose. Professional input was regularly recorded.

The provider worked effectively with staff, health and social care professionals and other services to coordinate people's care and support continuity when their needs changed or they moved between services.

Records showed regular involvement from a range of healthcare professionals. This included general practitioners, dietitians, tissue viability nurses, physiotherapists, mental health services and palliative care teams. The registered manager told us, "The palliative team is really good and they come and help us whenever we need them."

Care records demonstrated that specialist advice was sought when people's needs changed and external professionals were involved in supporting people with complex health conditions.

A professional told us staff identified concerns appropriately and escalated changes in people's condition in a timely way. They described good collaborative working between the home and healthcare professionals.

Staff described established admission and hospital transfer arrangements. Pre-admission assessments gathered information from hospitals, families and healthcare professionals before people moved into the service. Nurses told us relevant information was shared with ambulance crews and hospitals when people transferred for treatment. This included medicines administration records, mobility information, dietary requirements and resuscitation status. Staff also described regular contact with GPs through visits, telephone calls, email and video consultations to ensure people's healthcare needs were met.

Relatives were generally positive about communication with the service and records demonstrated ongoing involvement from families and healthcare professionals.

The provider supported people to maintain their health and wellbeing and to access appropriate healthcare and specialist services when their needs changed.

People had access to a range of healthcare services and specialist support. Records showed people had regular access to a range of healthcare professionals. Specialist support was sought when required to meet people’s individual health needs. Staff recognised changes in people's health and sought advice from healthcare professionals when required. One person told us, "I had a fall and they arranged hospital." A relative described physiotherapy helping their family member regain mobility and confidence following a period of ill health.

People with specific health conditions received support from relevant professionals. Records showed referrals were made when concerns were identified. Staff described working closely with healthcare professionals and following their recommendations to support people safely. People were also supported to attend appointments and receive treatment when required.

Healthcare professionals told us staff responded appropriately to residents' healthcare needs and sought medical input when required. Urgent concerns were escalated outside routine reviews where appropriate.

The provider did not always effectively monitor, review and evaluate people's individual outcomes to identify whether care remained effective and to inform improvements in their care and support.

Care plan reviews often recorded that existing care should continue but did not consistently evaluate whether interventions remained effective, people’s needs had changed, or agreed outcomes had been achieved. As a result, records did not always clearly demonstrate how people’s progress and outcomes were being evaluated over time.

The provider completed audits and collected information about accidents, pressure damage, hospital admissions, deaths and other aspects of care. However, records did not consistently demonstrate how this information was used at an individual level to review risks, update care plans or inform changes to care.

Risk assessments were not always clearly linked to associated care plan interventions. Reviews also did not consistently demonstrate how changes in people’s needs, deterioration in health or learning from incidents had informed subsequent care planning.

Some handwritten records were not always easy to interpret. A professional who supported people at the service told us moving towards electronic documentation, including daily notes and bowel charts, would support information sharing and effective handovers between staff and multidisciplinary professionals.

Systems were in place to monitor aspects of care and quality. However, records did not consistently provide assurance that people’s individual outcomes were routinely evaluated and used to inform ongoing care planning and improvement.

The provider did not always ensure people's rights, choices and consent were consistently understood, respected and supported in accordance with relevant legislation.

Staff knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards was inconsistent. Some staff were unable to explain DoLS, mental capacity or how principles should be applied in practice. This meant the provider could not be assured staff consistently understood the legal frameworks used to support decision-making and protect people’s rights.

Records relating to bedrails, associated safety measures and other restrictive interventions did not always clearly demonstrate the decision-making of their continued use. This included decision-specific capacity assessments, best-interest decision-making and consideration of less restrictive alternatives. Reviews often recorded that arrangements should continue without evaluating whether they remained appropriate.

We also found examples where MCA documentation did not fully address the specific decision being made. This included decisions relating to medicines management and restrictive interventions. Care records did not always demonstrate how people’s wishes, preferences and choices had been considered when decisions were made about their care and treatment.

However, MCA and consent documentation was present for some people and the provider maintained a DoLS tracker. Staff generally sought consent before providing care.