Manor Park Nursing Home

Manor Park Nursing Home is a care home providing accommodation for up to 52 people who require nursing or personal care. At the time of our inspection 45 people were living at the service.

The service specialises in caring for people who are living with dementia. Manor Park Nursing Home is beside the sea front, and the original building has been adapted and extended to meet people's needs.

People’s experience of using this service and what we found

People were safe living at Manor Park Nursing Home. Staff knew how to recognise and report abuse. Risks to people were assessed and mitigated. There were enough staff to meet people’s needs and staff were recruited safely.

People received their medicines safely. There were a range of health and safety checks in place to ensure the environment was safe. Learning from incidents and accidents was cascaded to the team. There were appropriate infection control measures in place, however we observed one occasion where the measures were not being followed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were effective systems in place to monitor the quality and safety of the service. People’s relatives and staff were positive about the management of the service and staff team. There was a positive culture within the service, staff said morale had improved and spoke positively about the people they supported.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 28 July 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manor Park Nursing Home is a care home providing accommodation for people who require nursing or personal care. At the time of our inspection 41 people were living at the service. Some rooms were not in use because of building works, but up to 52 people can live there.

The service specialises in caring for people who are living with dementia. Manor Park Nursing Home is beside the sea front, and the original building has been adapted and extended to meet people’s needs.

People’s experience of using this service and what we found

Medicines were not always stored safely, or records did not always evidence safe storage. Some records needed to be reviewed or updated. Most issues had already been identified by the clinical manager and action was taken during and immediately after the inspection to make improvements. We have made a recommendation about medicines safety.

People’s capacity to consent to their care had been assessed, but specific decision making processes were brief. We have made a recommendation about this.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People were protected from the risk of harm because the service assessed, monitored and managed safety. We were assured that people were protected by the prevention and control of infection. Care records helped people receive the support they needed because staff could access informative records. The environment and equipment were regularly checked, and actions taken when required to minimise risk.

The service had enough staff, including for one-to-one support. There had been recent pressures during an outbreak of Covid 19 at the service, but emergency plans had been put into place to ensure people remained safe. Safe recruitment practices were in place. People were supported by staff who had the training, knowledge and skills to carry out their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had care plans which were personalised and reflected their needs and preferences. These were regularly reviewed to ensure they continued to meet people’s needs and were informative.

People received support to eat and drink enough to maintain a balanced diet. Preferences and needs were documented in care records, and staff knew when people needed support or equipment to eat, drink and remain healthy. Referrals were made to specialist services as required.

There had been recent staff changes at all levels, but the management team had a clear vision about the quality of care and service they aimed to provide. The new management team were open and keen to develop the service but needed time to embed changes.

Quality assurance processes were effective and helped to hold staff to account, keep people safe, protect their rights and provide high quality care and support. Shortfalls were identified and improvements planned where necessary, although time was needed to implement some changes. Staff worked in partnership with other organisations to develop the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 February 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We received concerns in relation to staffing, safeguarding and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manor Park Nursing Home is a residential care home providing personal and nursing care for up to 52 adults with a diagnosis of dementia. Four people under the age of 65 who did not have a diagnosis of dementia had also been admitted. There were 50 people living at the service at the time of the inspection. The service recently added an additional eight-bedded unit and planned to extend further. The service specialises in providing care for people with dementia.

People’s experience of using this service and what we found

We found three people who were placed at the service did not have all their needs identified and met. These people had a primary diagnosis of mental health and did not have dementia. There were no nursing staff trained in supporting people with mental health problems. These three younger people shared social space with people living with dementia, this meant they were not placed with people within their peer group which impacted on their opportunities for social engagement. One of the younger people had experienced significant avoidable harm at the home.

Risks to people were not always assessed and plans were not always in place to guide staff on how to keep people safe. We found some bedroom furniture was in poor condition which meant it could not be thoroughly cleaned. Some communal areas of the service could not be thoroughly cleaned due to the on-going building works.

Areas where the refurbishments had been completed were clean and bright; the environment had been adapted for people living with dementia. The provider had a range of communal spaces which aimed to group people by compatibility and their need for similar levels of support.

Staff adhered to infection prevention and control measures in line with Covid-19 guidance.

Quality assurance systems in place had not identified a poor culture which was identified following a serious safeguarding concern. Systems in place had failed to identify infection control risks within bedrooms. Systems had failed to identify the lack of appropriate risk assessments in place to keep people safe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 03 March 2020).

Why we inspected

The inspection was prompted due to concerns received about staffing, allegations of neglect, poor nutrition and fluids, culture of bullying and staff feeling unable to raise concerns to managers and because we received a notification of a specific incident. This incident is subject to a criminal investigation, so we did not examine the circumstances of the incident during the inspection. A decision was made for us to carry out a focussed inspection on the Safe and Well-led key questions to examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing risk, cleanliness and infection control and monitoring the safety and effectiveness of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Manor Park Nursing Home is a residential care home providing personal and nursing care to 42 people aged 55 and over at the time of the inspection. The service can support up to 44 people. The service follows the household model of care, where the home is split into different areas which are characterised by the stage of dementia that the individual is experiencing.

People’s experience of using this service and what we found

People received care and support that was safe. Medicines were managed safely, however, we made a recommendation that the provider looked at current best practice for recording guidance for staff on the use of ‘as required’ medicines.

The provider had a robust recruitment programme and staff had received training in recognising abuse and safeguarding people.

There were conflicting opinions of whether there were enough staff. However, we saw the provider had plenty of staff to meet people’s needs and look after people safely at the time of the inspection. Risk assessments were in place with guidance for staff about how to keep people safe.

People received effective care and support that was focused on the person. Staff demonstrated a very good understanding of people’s needs and received training relevant to their role and the needs of people living in the home.

People enjoyed a healthy, balanced and nutritious diet based on their preferences and health needs. However, people’s mealtime experience was varied. Some people enjoyed a social mealtime experience whilst other people’s experience was more task orientated. We recommended the provider looked at current best practice on ensuring people living with dementia have a social experience at mealtimes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received care from staff who were kind and caring. Staff always respected people’s privacy and dignity. People who could express a view told us they felt respected and valued. Where possible people were supported to express an opinion about the care provided and were involved in day to day decisions.

People received responsive care and support which was personalised to their individual needs and wishes. Activities were organised however; the service did not have a full plan of activities. The registered manager and staff supported people to follow activities of their choice as if they were living in their own home.

There was clear guidance for staff on how to support people in line with their wishes. People’s end of life wishes were recorded, and the home worked with other healthcare professionals to ensure people were comfortable and pain free.

People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Everybody spoken with said they felt the manager was open and approachable. All staff said they felt valued and respected.

There were effective systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and learnt from issues raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 8 May 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Manor Park Nursing Home is a care home with nursing. It provides nursing and personal care for up to 43 people who are living with dementia. At the time of our inspection 39 people were living in the care home. Building works are currently being undertaken in the grounds, with plans to add a further 20 bedrooms to the home.

What life is like for people using this service:

People were protected because staff were safely recruited. Sufficient checks were completed before staff started in post.

People received personal and nursing care from staff who were well trained and sufficiently supported in their roles.

Risk assessments and risk management plans were in place to make sure people received the care they needed and actions were taken when conditions changed.

Relatives told us they were confident that staff supported people to make sure personal care needs were met.

Quality assurance systems were in place, and when shortfalls were identified, actions were promptly taken.

The registered manager understood their responsibilities for sending notifications to CQC.

The service met the characteristics of Good in the two key questions we inspected. Therefore, our overall rating for the service after this inspection remained Good.

More information is in detailed findings below.

Rating at last inspection:

Good (report published in September 2018).

Why we inspected:

This was a focused inspection, undertaken in response to concerns we had received about the service. We had received two recent safeguarding concerns. One related to the care a person received before they were admitted to hospital and the other related to a person admitted to hospital with a pressure ulcer. The concerns were, later, not substantiated. We had also received a recent notification from the care home about another person who had acquired pressure ulcers.

Follow up:

We will continue to monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

Manor Park Nursing Home provides nursing and personal care for up to 36 older people with dementia. On the day of our inspection there were 36 people resident in the home.

This service is rated ‘Good’.

The service has 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.

The registered manager and provider had quality monitoring systems in place. These systems were used to improve the service and embed a culture of continuous improvement.

People were involved in how the home was managed. Regular meetings took place to give people a chance to have their say; the feedback was used to improve the home and the people's experience of living there.

Staffing numbers were sufficient to meet people's needs and this ensured people were supported safely. Staff and people we spoke with felt the staffing levels were appropriate.

Staff demonstrated a detailed knowledge of people's needs and had received training to support people to be safe and respond to their care needs.

Staff understood their safeguarding responsibilities and whistle-blowing policy and procedures. Staff supervision was undertaken regularly and staff felt well supported by the registered manager.

There were positive and caring relationships between staff and people at the service. People praised the staff that provided their care and we received positive feedback from people's relatives and visitors. Staff respected people's privacy and we saw staff working with people in a kind and compassionate way when responding to their needs.

Care provided to people met their needs. Care records provided personalised information about how to support people. We saw that the service took time to work with and, understand people's individual preferences in order that the staff could respond appropriately to the person. People were also supported to undertake person centred activities and be involved in the local community.

The staff had a good understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely. Meetings had been arranged in order to enable people's best interest to be assessed when it had been identified that they lacked the capacity to consent to their care and treatment.

There was a robust staff recruitment process in operation designed to employ staff that would have, or be able to develop, the skills to keep people safe and support individuals to meet their needs.

People had their physical and mental health needs monitored. The service maintained daily records of how people's needs were met and this included information about medical appointments with GP's and dentists.

There were suitable arrangements in place for the safe storage, receipt and administration of people's medicines.

There was a complaints procedure for people, families and friends to use and compliments were recorded.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience of staff. This helped to ensure that people's needs were always met.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Where people's needs meant they were not able to be involved in writing their care plans, this was recorded and other professionals and family representatives were involved to ensure people's best interests were taken into account. A relative told us "I'm now very happy and have been involved in developing my relative's care plan". Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, "the staff are nice" and "the staff care". A relative said, 'the staff are very good".

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly. The home had its own adapted minibus, which helped to keep people involved with their local community.

People knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. People told us "we say if we are not happy with things". Family representatives told us "the manager, nurses and staff listen if we make suggestions".

People can therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes. This helped to ensure that people received a good quality service at all times.

During the inspection we received a number of comments regarding the management team who had been in place for around six months. Staff told us "the manager listens and is very approachable" and "we see the manager valuing people and that encourages us to do the same". Family representatives told us "things have really improved with the new manager".

Staff spoken with said they always offered people choices and never took consent for granted. One member of staff said 'We always make sure people give consent. We respect people's wishes.' Throughout our visit we saw that staff always asked people if they were happy to be assisted before care was carried out.

People who were able to express an opinion verbally said they were very happy with the care they received at the home. One person told us 'I couldn't complain about anything, they do everything they can to help you.' A visitor that we spoke with said 'Throughout my relatives stay here the care has been excellent.'

We noticed that the home had a copy of the Local Authorities safeguarding policy on display in the manager's office. This meant staff had access to the up to date local procedure for reporting concerns or allegations.

Staff said that they were well supported in their roles. All asked said that they could ask for advice and support from more senior staff at any time. One member of staff said 'The support is amazing, you can ask about anything you're not sure of.'

Audits were in place to monitor the quality of the service provided and identify shortfalls. These include audits of medication, the premises and care plans.

Throughout the day we saw that people were able to choose where they spent time. Some people spent time in the large lounges whilst others sat in quieter spaces or moved around the communal areas.

At the time of our last visit to the home there was no easily accessible information about activities. This meant that people who lived at the home, or visitors, were unable to plan their day around activities that they wished to take part in. At this inspection a fortnightly activity plan had been placed in the main hall and around the home.

Systems had been devised to monitor the quality of the service offered. These needed to be further developed to ensure that they highlighted shortfalls and led to ongoing improvements.

The home had sent out a satisfaction questionnaire to relatives of people who lived at the home. We read the returned questionnaires and noted that relatives were generally happy with the care and felt that there had been improvements in the environment.