Manor Hall 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.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The culture of the service was positive and one where learning was part of everyday practice. We were told the management team were available and approachable to staff, people and families. One person said, “They do listen and I can see someone in charge if I need to.” A family member said, “Very open here, lovely staff, always available if I have a question, anything happens they tell me.” The management team told us that reflective practice was used when incidents or accidents occurred, “We use the incident as a lesson and we all learn from it.”

Staff explained that the management team shared outcomes of incident and accidents so they could learn from them and improve practice when things went wrong. For example, lessons learnt were discussed in staff meetings, supervisions and daily handovers. One member of staff discussed someone who had had lots of falls, and said, “We looked at everything, the medication, environment and introduced checks and safeguards, but they still fell but we tried.”

The management team told us they investigated accidents/incidents and had learnt from these. They gave an example of improvements they had made around people who experienced repeated falls, such as, sensor mats. They also demonstrated how they used root cause analysis to monitor medicine errors, urinary tract infections and pressure wounds so as to prevent re-occurrences. As discussed not all root core analysis forms were completed in full, with the details of the impact of the incident on the person or signed. This was taken forward by the management team. The service had a service improvement plan in place which detailed plans for ongoing improvements.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The management team worked with other health and social care professionals to make sure that people transitioned into the service smoothly. There were specific staff that dealt with the discharge to access beds from the hospital to ensure safe transition. There was currently work in progress to ensure communication with the GP and paramedics regarding these admissions were improved to ensure safe care. People moved on from the service only when they themselves chose to move, sometimes to be closer to loved ones or if the service could no longer meet their needs. People were only moved if they could not continue to be supported safely at the service. Staff told us of multi-agency meetings that took place when there were concerns about needs being met. These meetings involved relatives and all necessary professionals and made sure that the best outcomes were achieved for people.

People told us they were supported with proposed transitions and moves. A person said, “I met a staff member, can’t remember who, in hospital, they carried out an assessment there and then and here I am, not a bad place to be.” Another person said, “Someone came to see me in hospital and asked what I needed from them." People’s support needs were recorded and updated within care plans which meant that changing needs could be tracked and addressed as soon as changes became apparent.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Our observations found that people were comfortable with staff, we saw positive interactions, that assured us they felt safe and comfortable. We saw people approach staff throughout the site visits and staff engage with them in a kind, supportive way. People and their relatives told us that Manor Hall Nursing Home was safe. One person said, "I feel very safe here, they are kind to me.” Relatives' comments included, “[Person] is safe here, I am able to relax knowing they are safe" and “I have no concerns at all. The staff are gentle and kind I can talk to any of them if I was worried.”

Staff confirmed that they had read the policies as part of their induction and refreshed their knowledge at yearly safeguarding training. Training records showed staff had completed safeguarding training. Staff were aware of the signs of abuse and how to report safeguarding concerns. They were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored. One staff member said," I found the training really interesting, some things I had never considered as abuse, it makes you realise how vulnerable are residents are, and how important consent is." Another said, "I would take it to nurse or manager, unless it was an accident then I would ring emergency call bell. We get training every year, procedures and I would contact the local authority if I thought it hadn't been reported."

People were supported by staff who knew them well. Staff supported people with kindness, respect and followed good practice guidance when assisting them. Staff were mindful of people's preferred routines and promoted their dignity, people were dressed in their own clothes and well presented.

There was a system in place for recording safeguarding concerns which helped management have oversight over this. The management team had appropriately made safeguarding referrals to the local authority when required.
 

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed. Staff told us “All residents have care plans and risk assessments which we read, we have daily meetings to discuss any changes, I think we have a good grasp of risk.” We discussed with staff, certain people who had either bruising or dressings on and they were able to discuss how they occurred, what actions had been put into place and any potential risks. Staff told us that additional checks were in place for people at risk of falls. These included sensor mats, 30 minute location checks, appropriate footwear checks, and ensuring people had the appropriate walking aids and were wearing their glasses if needed. Peoples’ footwear was an area identified to be taken forward by the management team for review.

We spent time with people and staff both in communal areas and with permission in peoples' bedrooms. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against people’s weight. Staff recorded these checks on the persons’ care documentation. People who were at risk from falls, had low beds, and sensor mats that alerted staff the person was up and at risk. Call bells were in peoples' rooms, and there were risk assessments in place for those who could not use a call bell and we saw that staff checked them regularly.

There were people who lived with diabetes and we saw that staff monitored their health, lifestyle choices and liaised with health professionals as necessary. People at risk of choking had been assessed and referred as necessary to the GP and Speech and Language therapists (SaLT) to ensure risk was mitigated by modified food and drinks. Emergency equipment to deal with choking was ready for use and regularly checked.

We observed equipment being used appropriately to reduce people’s individual risks, such as walking aids and wheelchairs. People were supported with the correct equipment and assisted by staff in a safe way. Care plans and risk assessments included clear guidance for staff on how to minimise risks, for example, for people at risk of dehydration and malnutrition, there was evidence of close monitoring and included the actions taken by staff of fortifying food or use of supplements.
Wound care documentation was in place for those with wounds, which included photographs and details of treatment in line with good practice guidance with evidence of wound improvement.

All staff received fire training and undertook night and day evacuations to ensure all staff have confidence in the event of fire to manage people safely. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. The premises were a mixture of old and new, and before admission consideration was given to people’s mobility and mobility aids to ensure peoples safety. People had access to both internal and external spaces which were safe and promoted independence.

The environment was safe and well cared for. Care equipment we saw was in good working order and documentation to support regular servicing was seen. There was no clutter, and the home was accessible for people with mobility needs and safe for those who walk with purpose.

Processes ensured the environment was safe and well kept. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The staffing levels were based on peoples’ needs and regularly reviewed. We looked at 3 months of rotas and the staffing levels were consistent and supported by relief staff to cover vacant positions, sickness and holidays. Staff numbers and the deployment of staff had ensured people’s needs were met in a way that met their preferences. Care delivery was supported by records that evidenced that people’s care needs were being met.

Our observations showed us that staff were visible and available to support people’s requests for help and take the time to sit with people, to assist them with food and drink if necessary. People received timely care, and call bells were mostly answered promptly. When a care bell was not answered it went to an emergency call and we saw all staff respond, including management staff. People we spoke with did not have any concerns regarding staff numbers. People told us, “Always quick to respond, sometimes breakfast is slow, but it’s always hot,” and “The staff are quick to answer my bell, I get supported and they don’t rush me, so I think the staffing levels are good.”
Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. However, on the first site visit there were strong unpleasant odours in certain areas of the home. This was immediately dealt with by deep cleaning carpets and odours were minimised.

In all other areas the premises provided people with a clean, and well-maintained environment. People’s rooms were cleaned regularly by housekeeping staff and people commented positively, with no-one reporting any problems with the standard of cleanliness of the environment and equipment.
People told us, “Nice and clean,” and “They (housekeepers) are good and kind, they take care of my photographs and my belongings for me.” Visitors told us the home was clean and well maintained. “A visitor said, "Well-kept, clean and welcoming."

Staff told us they are well resourced for cleaning and infection control. One said, “Personal protective equipment (PPE) is not an issue, we have enough and also cleaning products and equipment.”
We saw housekeeping staff undertaking cleaning in all parts of the home. People’s laundry was managed well, and the laundry room was clean and well organised and people were well dressed.
The housekeeping staff understood their role and followed appropriate procedures to keep the home clean. All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed by the infection control lead to ensure compliance with the procedures and policies of the home. Staff were trained in the use of PPE and of the importance of good hygiene practice. The manager told us they ensured staff continued to follow Public Health England guidance to reduce risk of infections.

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.

Staff supported and involved people to manage their medicines and followed best practice for administering medicines. Staff documented medicines clearly in care plans and made them available when people moved between healthcare settings.

Not everyone could share their experiences regarding medication, but one person said, “They support me to take my pills,” and “I leave it to them to organise, but they do tell me of changes.” One family member we spoke with said, “We are kept informed of any changes, especially if the GP changes the medication, I don’t have any worries.”

Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and that they were recorded accurately on the electronic medication administration record (eMAR). Risk assessments were in place for certain medicines. For example, those on blood thinners, had a risk assessment in place in case of an injury. All discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. Protocols for 'as required' (PRN) medicines such as pain relief medicines were in place however, they were very generic and lacked personalisation. This had been identified by management team and was being addressed.