Manordene

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant services were not planned or delivered in ways that met people’s needs.

The service was in breach of legal regulation in relation to people not receiving person-centred care and people’s complaints not being investigated and responded to.

This service scored 25 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

People and relatives told us there was a lack of person-centred activities in the home. Comments included, “There is not a lot of entertainment”, “I get bored and fed up” and “I don’t think (person) is being stimulated. In the morning, they put ‘auction houses’ on the television but they could put on a nice film. I haven’t seen any activities at all.” One visiting professional told us, “They could entertain them a little bit more. Turning the TV on and just sticking them in front of the TV is not adequate. If they can improve on that front and have a separate quiet lounge. For any human sitting in the lounge, you would lose the will to live.” During our visit, the majority of people were just sat in the lounge with very little to occupy them aside from the television being on. A member of staff said, “They do get bored. There is not much entertainment.”

Staff felt the home was not set up to suit the needs of people living with dementia. One told us, “The lounge itself is small, there is nothing sensory in there or in the corridors.” Where people spent time in their rooms, there were no one-to-one activities arranged for them.

Leaders failed to ensure people’s care plans contained sufficient information around their life history. We found the people’s care plans contained little or no information around their life histories. There was a lack of information including childhood and early life history, work history and significant places and life events to encourage reminiscence, which could help them retrieve past memories. Staff we spoke with about this lacked knowledge of people’s life history. Life history is crucial in dementia care because it helps staff understand people’s past, preferences, and personality, which can improve communication, tailor care to their needs, and enhance their overall well-being. By understanding the people’s life story, staff can better connect with them, address distressed behaviours, and create a more person-centred approach to care. We found the provider had not done this.

There were shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not joined-up, flexible or supportive of choice and continuity.

People did not always experience continuity in relation to meeting their needs. The provider's processes to ensure people's ability to be integrated into their local community needed improvement. We received feedback people's activities were not always promptly organised, for example people’s ability to go out was affected by the lack staff available. We were not assured these concerns had been identified by the provider's own systems to ensure their effectiveness. There was a blanket approach to the delivery of care without consideration of people’s diverse needs including those living with dementia or a mental health diagnosis.

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

The leaders had not used various alternative communication aids for people with a cognitive impairment including dementia. There was no dementia friendly signage to orientate people including to the toilet, bathrooms and people’s bedrooms. There was no dementia friendly information in the lounge to remind people of what day it was and the time. The menus were not in picture format and staff were not offering a visual display of meals to people during lunch. We observed a member of staff offering a person a choice of pudding. However, the person was unable to understand what those choices were. Rather than show the puddings to the person, the member of staff held up both hands and told the person that each hand represented a pudding and asked them to choose which hand they wanted. This demonstrated a lack of understanding by the member of staff of how to present information to a person living with dementia.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

People were not always encouraged to feed back any areas for improvements. We were told people had key worker meetings however there was no record of any meetings they had with people. There were no surveys provided to people in an accessible format to gain any feedback from them. There had also been no resident or relative meetings to seek feedback to influence changes.

Although day staff were able to attend face to face meetings, night staff had not had this opportunity. The registered manager told us, “I have done it (a meeting) over the phone, that was not recorded to be honest with you. I literally have 1-1 over the phone with them but my intention is to come in and to a night visit. That is in the pipeline.” There had also not been any staff surveys undertaken.

The provider did not make sure that people could access the care, support and treatment they needed when they needed it.

Although some people were supported to access external professional support, this was not consistent and as such meant that not everyone was being given equal opportunities. There was a lack of evidence of each person's self-defined strengths, preferences, aspirations and needs as the basis on which to provide care. One external professional told us, “Just because they have dementia, with the right support they can be encouraged to do things and improve their quality of life.”

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

People did not always have the opportunity to experience things that meant something to them. Relatives were restricted from visiting during lunch without any consultation with people about this. Leaders moved 1 person from their room into a shared room without considering whether this was either of them wanted. Leaders also did not always make an effort to enable people to participate in their preferred activities.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

One relative told us they had not been asked to be involved in the end-of-life care planning for their loved one who had advanced dementia. They said, “I really want an advanced care plan, I have asked about that, really, I don’t want her going into hospital. If she is ill, if she has an infection, I really want to know in advance what the state of play is.” Staff also fed back to us that they would like more training around supporting people nearing the end of their lives. One told us, “I would have liked to have done it (training) because we do have a lot of palliative care here. I would like to do a bit more.”

The end-of-life care plans were not detailed and just had basic information around whether a person wanted to be resuscitated. This was despite this being a nursing home where they cared for people on palliative care. An end-of-life care plan in a nursing home should be a personalised document covering comfort, dignity, and wishes, including medical and nursing support for pain and symptom control, emotional and spiritual support for the resident and family, clear guidance on treatment preferences and resuscitation decisions, identification of preferred visitors and decision-makers, and arrangements for bereavement support. When people were nearing end of life the local hospice did attend the home to support people and staff.