Archived: Manor Hall Nursing Home

Updated 19 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 3 and 6 November 2017 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we held about the home, including previous inspection reports. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

During the inspection we reviewed the records of the home. These included staff training records, three staff recruitment files. Training and supervision records, medicine records, complaint records, accidents and incidents, quality audits and policies and procedures along with information in regards to the upkeep of the premises.

We also looked at five care plans and risk assessments along with other relevant documentation to support our findings. We also ‘pathway tracked’ people living at the home. This is when we looked at their care documentation in depth and obtained views on their life at the home. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection, we spoke with 11 people who lived at the home, seven visiting relatives, and ten staff members individually and a group of six care staff. We also spoke with the deputy manager and director. We also spoke with three health and social care professionals Following the inspection we spoke with a further health and social care professional who visit the service to ask for their feedback.

People who lived at Manor Hall nursing home were not all able to verbally share with us all of their experiences of life at the home because of their dementia needs. Therefore we spent time sitting and observing people in areas throughout the home and were able to see the interaction between people and staff and watched how people were being cared for by staff in communal areas. This included the lunchtime meals. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 19 December 2017

This inspection took place on 3 and 6 November 2017 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Manor Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Manor Hall Nursing Home provides nursing and personal care for up to 44 people in one adapted building. There were 36 people living at the home at the time of the inspection. They had a range of complex health care needs which included people who have stroke and diabetes. Manor Hall Nursing Home also provides care and support for people who require end of life care. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care needs. Accommodation was provided over three floors with a passenger lift that provided level access to all parts of the home.

There is a registered manager at the home. 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 time of the inspection the registered manager was temporarily not working at the home. In her absence the deputy manager was responsible for the day to day running of the home with support from the operations director.

At our previous inspection in August 2016 we found the provider had not met the regulations in relation to ensuring there were enough staff deployed. People had not always received the care they wished for or required and people’s records were not always accurate or complete. The provider sent us an action plan and told us they would address these issues by November 2016. At this inspection we found improvements had been made and the provider was meeting the regulations. However, further time is required to ensure these improvements are fully embedded into practice.

There was a quality assurance system in place and this had identified the shortfalls we found. This was evident from the audits, meeting minutes and discussions with the director, deputy manager and staff. We had previously identified people’s records were not consistently person-centred and did not all include the information staff may require. Improvements had been made but further work was required to ensure this was fully embedded into practice. Work was also ongoing to ensure people were able to take part in activities they enjoyed and were meaningful.

Staff knew people really well. They had a good understanding of people’s individual needs and choices. They could tell us about people’s personal histories including their spiritual and cultural wishes. Each person was treated as an individual and their choices and rights were respected and upheld.

People were supported by staff who were kind and caring. Staff knew people well and had good relationships with them. Staff maintained people's privacy and understood the importance of confidentiality. Relatives were able to visit at any time, and were made to feel very welcome.

There were enough staff working to meet people's needs. Staff were deployed to ensure there was a good skill mix in each team. Staff were suitably trained and supported to deliver care in a way that responded to people's changing needs.

There was a range of risk assessments in place and staff had a good understanding of the risks associated with caring for people at the home.

The management and storage of medicines was safe, and people received their medicines as prescribed. Staff were attentive to people who may be in pain or discomfort and were supported to ensure they received their medicines when they needed them.

Staff ensured people had access to external healthcare professionals when they needed it. Referrals to external healthcare professionals were made in a timely way.

Staff had a good understanding of the Mental Capacity Act 2005 and DoLS and how to involve appropriate people, such as relatives and professionals, in the decision making process. Best interest decisions were made when necessary.

People’s nutritional needs were met. People were provided with a choice of food and drink that met their individual needs.

There was a complaints policy in place and people and visitors told us they would raise any concerns with staff. They were confident issues raised would be addressed.

There was a positive culture at the home. Staff were involved and updated about changes at the home through meetings and at handovers each day. The deputy manager and director had good oversight of the home and knew where changes and improvements were needed.