Archived: The Manse Nursing Home

We found the following examples of good practice

¿ The provider's systems allowed people to be admitted to the home safely. The designated unit was separated to prevent cross infection with the rest of the home. There was no movement of staff or residents between units.

¿ There was an established staff team to provide continuity of support on the designated unit. The provider had contingency plans in case of a staff shortage.

¿ National guidance was followed on the use of personal protective equipment (PPE). There was clear signage on the correct use of PPE and handwashing techniques and staff had received appropriate infection control and prevention training.

¿ The provider had thoroughly assessed the risks to ensure safe visits could take place. This included a booking system, to allow for social distancing, health screening and use of PPE. Staff also supported people to make use of technology, such as phone and video calling, as an alternative to visits. A robust system was in place for staff and other professionals to follow when entering and leaving the building.

¿ Additional housekeeping and checks were completed to ensure the home was clean and hygienic.

¿ There were detailed risk assessments to manage and minimise the risks COVID-19 presented to people who used the service, staff and visitors. The registered manager had consulted with staff about any personal risks or concerns.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

The service had improved since our last inspection.

People’s medicines were managed safely and properly. Staff followed infection prevention and control guidelines. People received personalised care that was responsive to their needs and preferences. We received mixed feedback about staffing levels from people who used the service and staff. However, the service had used a dependency assessment tool to calculate staffing which showed staffing was sufficient. The registered manager confirmed they would keep this under close review. There were some areas identified within the home that did not meet infection control guidelines. The manager addressed this during our inspection. People had opportunity to access a range of activities including access to the local community. However, we received mixed feedback about activity provision. The activities coordinator had begun work to ensure the activities provided by the service met people’s individual needs.

We received positive feedback from people about The Manse Nursing Home. People told us it was safe and that staff were kind and treated people well. Staff understood the importance of providing person-centred care and treated everyone as individuals, respecting their abilities and promoting independence. People’s capacity to consent had been assessed in line with legal requirements. Staff had built positive caring relationships with people they supported and their families. Staff liaised with other health care professionals to ensure people's safety and meet their health needs. We received positive feedback about how the service was managed. The provider had auditing systems to ensure they met legal requirements.

More information is in the full report.

Rating at last inspection: Requires improvement (Report published 31 October 2017).

About the service: The Manse Nursing Home is registered to provide 24-hour care for up to 44 people. Bedrooms are located on the first and ground floors and all have ensuite facilities of a toilet and washbasin. Lounges and dining rooms are on the ground floor. The home is close to the centre of Kirkham with easy access to shops and local amenities. There are small gardens to the front and sides of the home, with patios and seating areas, accessible via ramps. At the time of our inspection, 36 people were living at the home.

Why we inspected: This inspection was a planned inspection based on the previous rating.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

The Manse Nursing Home is registered to provide 24-hour care for up to 44 people. Bedrooms are located on the first and ground floors and all have ensuite facilities of a toilet and washbasin. Lounges and dining rooms are on the ground floor. The home is close to the centre of Kirkham with easy access to shops and local amenities. There are small gardens to the front and sides of the home, with patios and seating areas, accessible via ramps. At the time of our inspection visit, there were 41 people who lived at the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in October 2016, we found the provider was not meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to safe care and treatment around medicines management. Following that inspection, the provider sent us an action plan which told us how they planned to make improvements for people who used the service. During this inspection, we checked to see what improvements had been made. We found the provider had made positive changes and the service was now meeting legal requirements.

We saw staff used safe systems when administering medicines. Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.

However, we found guidance for staff on the use of medicines prescribed for use ‘as and when required’ was not sufficiently detailed. We have made a recommendation about this.

The registered manager told us they observed medicines administration, but had not recorded any formal checks on staff competency. Following our inspection, we received assurances from the provider that checks on staff competency to administer medicines were being undertaken and recorded.

A range of audits and checks were available for the registered manager to use to assess, monitor and improve the service. However, these were not being completed as regularly as they should have been, due to a member of the management team being on extended leave from duty. This meant areas for improvement may not be identified and addressed in a timely manner. Following our inspection, we received assurances from the provider that quality assurance checks were now taking place as planned.

Environmental risks and risks to individuals were assessed and measures put in place to reduce or remove them, in order for care and support to be provided safely. Sufficient information was available to guide staff on how to support people safely.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met. Recruitment processes were used to ensure only suitable staff were employed to work with people who may be vulnerable.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding vulnerable adults training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People told us they were involved in planning their care and had discussed and consented to their care. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems within the home supported this practice.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met. We saw staff responded promptly when people had experienced health problems.

Comments we received demonstrated people were satisfied with their care. The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at the home.

Care plans were organised and had identified the care and support people needed. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People told us they were happy with the activities organised at the home. The registered manager explained this was an area they had identified for improvement to ensure people were able to participate in activities that were meaningful to them.

A complaints procedure was available and people we spoke with said they knew how to complain. People and staff spoken with felt the registered manager was accessible, supportive and approachable.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people for input on how they could continually improve the service people received.

At the last inspection on 30 May 2013 the service was meeting the requirements of the regulations that were inspected at that time.

The Manse Nursing Home can accommodate up to 43 people who require nursing or personal care. Bedrooms are located on the first and ground floors and all have ensuite facilities of a toilet and washbasin. Lounges and dining rooms are on the ground floor. The home is close to the centre of Kirkham with easy access to shops and local amenities. There are small gardens to the front and sides of the home, with patios and seating areas, accessible via ramps. At the time of our inspection visit there were 43 people who lived at the home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found the services medicines practices were unsafe. This was because we saw medicines were left unattended and out of sight of nursing staff and were accessible to anyone walking along the corridor. We also observed Medication Administration Records completed by nursing staff before they had given people their medicines. Records should only be signed for after medicines have been administered to confirm the person had received their medicines and to keep accurate records.

This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who lived at the home and their visitors told us staff who supported them were kind, caring, polite and professional in their approach to their work. Comments received included, “The staff are brilliant here. I only came in for a short stay and decided I didn’t want to go home.” And, “I am very happy with my care. The staff are very kind and pleasant. I have never seen a sulky face.”

One person who had recently moved into the home told us they had chosen the home because it had been known to them by reputation. The person said, “I have to say the home has met all my expectations. I have been amazed how easy it has been for me to settle in. I am being cared for by friendly and helpful staff.”

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us they felt safe because staff responded when they required their help. One person said, “As you can see I have my buzzer next to me if I need to call for help. They never keep you waiting.”

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at the recruitment of three recently appointed staff members including one registered general nurse (RGN). We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

The service had checked when recruiting nurses that they were registered with the nursing and midwifery council (NMC). These checks had been repeated regularly to ensure nursing staff were still registered with the NMC and therefore able to practice as a registered nurse.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived with dementia. We found staff were knowledgeable about the support needs of people in their care.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. No offensive odours were observed by the inspectors. We spoke with 12 people who lived at the home and three people visiting their relatives. They told us they were happy with the standard of hygiene at the home. One person visiting the home said, “The place is always clean when I visit. I have never smelt any unpleasant odours which I have come across when visiting other homes.”

We found equipment used by staff to support people had been maintained and serviced to ensure they were safe for use.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration. Comments received included, “I enjoy all my meals, the cook is brilliant.” And, “The meals are very good. I have never been given anything I couldn’t eat.”

People told us they enjoyed the activities organised by the service. These were arranged both individually and in groups. One person visiting the home said, “They try very hard with activities to keep [relative] entertained. [Relative] was a keen gardener before moving into the home. We spent yesterday afternoon potting plants around the grounds.”

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

We found people had access to healthcare professionals and their healthcare needs were met. A visiting healthcare professional told us communication between them and staff was good and they were impressed with staff knowledge about people’s care needs.

We observed staff supporting people with their care during the inspection visit. We saw they were kind, caring, patient and attentive.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.

You can see what action we have asked the provider to take at the back of the main body of the report.

"I'm very happy here... I Know if I needed help I would get it...Everyone is treated with respect...They encourage independence with the things I can do and respect my privacy with things like the toilet."

"The cleaners are brilliant...Beds are changed every day and [Relative's] room is always spotless."

"If there was something wrong, I know I could speak with the matron...I'm confident they'd sort it out."

We found that people experienced care, treatment and support that met their needs and protected their rights. Needs assessment and person centred planning of care were of a good standard. People were happy with the activities at the home.

People who lived in the home were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. This included the use of appropriate policies and procedures and staff training.

People were protected from the risk of infection because appropriate guidance had been followed and people were cared for in a clean, hygienic environment. Staff were clear on their roles and responsibilities with regard to cleanliness and infection control.

People who lived in the home, their representatives and staff were asked for their views about their care and treatment and they were acted on. There was an effective complaints system available. Comments and complaints people made were responded to appropriately.