The Manor House 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

People told us they felt safe living in the home. Staff told us they felt confident to raise safeguarding concerns with the manager or local authority if they felt people were at risk of harm. People received their medicines in a dignified manner and staff wore personal protective equipment when needed. However, further improvements were needed when administering medicines using skin patches. Staff told us they regularly worked with other health professionals to keep people safe. Visiting professionals told us they had raised concerns over the care and support provided to people. However, visiting professionals were working closely with the provider and improvements had been made. People told us there were enough staff on duty and we found staff were recruited safely. People told us they lived in a clean and safe home. However, some health and safety monitoring checks had gaps in the records. The manager responded to our feedback by introducing new systems to monitor people’s skin patches and audit health and safely records.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they received support from health professionals when required. One person said, “I used to have pain, but I don’t anymore. I have had some physiotherapy support and they [the provider] have equipment to help me sit up.” Relatives told us the provider supported people when they experienced distressed behaviours. One relative said, “The longer [my family member] has been here, the better their behaviours are managed.” Relatives told us people’s care was regularly reviewed. One relative told us, “My [family member] is supported 1 :1. Their care package is reviewed all the time.”

Staff told us they worked with other professionals to ensure continuity of care. One staff member said, “Every Tuesday, we have a nurse practitioner come from the surgery for rounds. Once a month, the GP comes for a round to review people at the end of their life. Sometimes we need to refer people to the tissue viability nurse. We refer to the dietetic nurse if we are concerned about blood sugars. All these professionals are involved.” However, visiting professionals told us further improvements were needed to improve the care and support provided to people. The manager told us they were working closely with visiting professionals to make improvements to the care provided.

Visiting professionals told about their concerns they had raised with the provider. They had raised concerns over staffing levels, the high number of unexplained injuries and the detail recorded in care plans. During this assessment we attended a meeting with the provider and visiting professionals to discuss these concerns and review the action taken by the provider. All professionals agreed the risk to people was reduced. However, actions were still ongoing with support from visiting professionals to further improve the care and support provided to people. The provider told us they would continue to work with professionals, people and relatives to ensure people lived in a safe home.

The provider raised referrals to other professionals when required, this included dietitians, tissue viability nurses, speech and language therapists. However, further improvements were needed to the overall governance and monitoring systems in place. The provider responded to our feedback by introducing new auditing systems and monitoring records. We will assess the success of these new systems in the next assessment.

People told us they felt safe living in the home. One person said, “I would speak to staff if anything wrong. I do feel safe here.” Another person told us, “I feel safe all the time here.” Another person told us about a concern they had raised. They told us they reported this to a staff member and the concern was resolved. Relatives told us people were supported safely. One relative said, “My [family member] feels safe here. The staff help to support [my family member] when they are feeling distressed.” Another relative said, “I don’t worry about [my family member] here. I think [my family member] is safe here because staff regularly communicate with me.”

Staff told us they received safeguarding training and they felt confident to raise concerns. One staff member said, “I've done safeguarding training. There is physical, psychological, sexual and financial abuse. If I spot anything of concern, I would need to report to my line manager. I would be confident they would deal with it in the right way. There is a safeguarding policy. I would escalate to the local authority safeguarding team if nothing was done.” Another staff member said, “It’s everyone’s responsibility to report safeguarding concerns.”

We observed staff interacting positively with people. Staff were responsive and proactive when checking with people if they needed support.

The provider raised safeguarding concerns in accordance with regulatory duties. The safeguarding policy was accessible to staff.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they lived in a safe home. One person said, “The staff do lots to keep me safe. I feel relaxed and calm.” They told us how staff supported them safely. Relatives told us they had been involved or witnessed fire evacuation drills. One relative said, “There are regular fire tests. The last one was 3 weeks ago, when we went outside.”

Staff told us they received training in the safe use of equipment such as hoists and other moving and handling equipment. However, we raised concerns over gaps in health and safety monitoring records. The manager responded to our feedback and introduced a new system to review health and safety monitoring records every month.

We observed people being supported in open communal areas enabling people to mobilise safely. We observed people being safely supported to transfer using hoists. However, 1 person required a pressure cushion in their seat, this was not in place and another person’s mobility aid was in their bedroom when they were seated in the lounge. The provider responded to our feedback and reminded staff to read the care plans and check people’s equipment was in place and accessible to them.

The provider ensured external health and safety companies carried out safety checks in accordance with statutory requirements and they acted on their recommendations. However, there were gaps in the internal health and safety monitoring records. The manager responded to our feedback by introducing new auditing systems to check health and safety monitoring each month.

People told us there were enough suitably qualified staff available to support them. One person said, “When I press my buzzer, they [staff] come. I don’t have to wait long.” Another person said, “There is enough staff. I have not noticed any difference at night or weekends.” We received mixed feedback regarding staffing levels from relatives. Some relatives told us there were enough staff on duty. One relative said, “The home seems to be well staffed. There is no difference at weekends.” Another relative told us, “My [family member is supported on a 1:1 level. There are enough staff.” However, some relatives raised concerns over the levels of agency staff. One relative said, “There have been more agency staff in the last three months.” Another relative said, “There is never enough staff. Some agency staff do not speak English.”

Staff told us there were sufficient numbers of staff on duty to meet people’s needs. One staff member said, “I think we have enough staff to take good care of people.” Another staff member told us, “We have enough nurses to manage people's clinical risks. The nurses will support a person if needed.” Staff told us they received sufficient training to keep people safe. One staff member said, “We have been trained and are qualified to take good care of people. We have both online and face to face training. The management team remind us to complete any overdue training.”

There were enough staff on duty to support people safely and when people asked for support, staff were available to support them without rushing.

Staff were recruited safely. Recruitment files showed all pre-employment checks had been made to ensure only staff who were suitable to work with people were employed. Staff rotas were in place and the management used a staffing dependency tool. A dependency tool can help a provider identify how many staff members are needed each day and time. Staff received mandatory training. However, where staff required training in people’s specific health conditions, not all staff had completed their training. The manager told us they sent regular reminders to staff to complete any missing training, although this had not always been successful. The manager told us they would review this process to ensure all staff completed their training appropriate to their roles.

People told us they lived in a clean environment and staff supported them safely, respecting infection prevention control practices. One person said, “It is very clean here, it smells nice”. Another person said, “The home is very clean, staff wear gloves and aprons. On one occasion a new staff member misplaced her gloves and the other staff reminded them”. Relatives told us the home was regularly cleaned. One relative said, “This is the cleanest home [my family member] has lived in. Staff wear gloves and aprons” Another relative told us, “My [family member’s] bedroom is very clean and tidy. Staff always wear gloves.”

Staff told us they received training in personal protective equipment (PPE) and infection control. The manager told us cleaning schedules and practices were regularly audited in the home.

The home was visibly clean and free from malodour. We observed staff wearing gloves and aprons when needed during lunch time. Hand sanitiser was readily available. We observed infection prevention control (IPC) signage was visible around the home.

The provider carried out IPC audits and the manager checked IPC practices on daily walk arounds. Records evidenced staff were trained in infection prevention control.

People told us they received the medicines safely. One person said, “The staff are very helpful, they tell me about my medicines. Another person said, “The nurse brings me my medicines. They are very good they don’t forget them.” Relatives told us staff discussed people’s medicines with them. One relative said, “Staff talk to me about [my family member’s] medicine all the time. Fluids are especially monitored.” Another relative told us, “I know what medication [my family member] is on. I am confident staff would contact me if there was a problem.”

Staff told us how they safely administered medicines. One staff member said, “I administer medicines. I have done medicines training and I have my competencies checked.” Staff told us how the provider took action following any mistakes. One staff member said, “I was supposed to give [medicine] but I didn’t give the right quantity. I completed a supervision to review my mistake.”

Medicines were managed safely by suitably trained staff. People got their medicines at the right time and medicines were reviewed regularly. An observation of medication administration showed how people received medication in a dignified manner and medicines were stored securely. However, some people received their medicines through the application of skin patches. The system in place for recording the location on the body where the patches were last applied was not sufficient to demonstrate they were being rotated in accordance with the manufacturer’s guidance. This is important because manufacturers of these patches set out how often a patch can be applied to one part of the body to reduce the risk of side effects. The manager responded to our feedback and introduced a new recording system.