About the service: Manor Barn Nursing Home accommodates up to 31 people, some of whom are living with dementia and who need support with their nursing and personal care needs. On the days of the inspection 26 people were living at the service. Manor Barn Nursing Home is a large property with accommodation over two floors. There is a communal lounge, a communal dining room and enclosed garden.

At this inspection we found the service to be Requires Improvement overall. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

At the last inspection in December 2017, we found three breaches of Regulation. We made requirements for these to be addressed and the provider sent us an action plan to show what they would do to improve people’s safety. At this inspection, we confirmed the provider had taken sufficient action to address the previous breaches of Regulation.

Risk assessments were completed for people and gave guidance about people’s care needs but the guidance was not always followed. For example, skin integrity plans or pressure care plans guided staff on people’s care needs but there were inconsistencies in the pressure care for some people.

The provider did not consistently check risks in the home environment, for example we found broken furniture in communal areas but people had not been harmed and when we told staff about this they took immediate action to remove the broken furniture.

Bruises and marks were not consistently recorded by staff and the provider did not monitor or have oversight. We raised this to the deputy manager and training and compliance manager and they immediately took steps to develop and implement a bruises and marks care plan. We recommended that the provider continues to trial a bruises and marks care plan and to start recording and overseeing where people have bruises and marks.

People were not always supported by their preferred gender of staff, for example during personal care. People gave us mixed responses about this. We recommended that the registered manager ensures that where people have made a preference that this is consistently respected through staff rota’s.

People had access to a structured activities programme. Some people were cared for in bed, due to this they were at risk of social isolation. The provider had made efforts to increase opportunities to have visits from an activities coordinator once to twice a week to people’s rooms. During the inspection we saw activities staff visiting people in their rooms but this continued to be an area of improvement.

People were supported by a consistent staff group. Recruitment processes were robust and safe. Staff told us they felt supported and management told us they felt supported by the provider.

People told us staff were kind. Relatives told us staff were caring and compassionate. Provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

Staff were trained to meet people’s needs. People were protected from abuse and staff knew how to keep people safe in an emergency such as a fire.

Care plans were comprehensive, up to date and covered all assessed risks and needs for people. People and appropriate relatives were involved in planning their care.

People’s medicines were well managed and given according to people’s preference. People were supported to access health and social care professionals to maintain their health and wellbeing.

Rating at last inspection: Requires Improvement; The last report was published on 31 January 2018

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for ‘Requires Improvement’ services. If any concerning information is received we may inspe

Manor Barn Nursing Home is registered to provide accommodation for up to 31 people, some of whom are living with dementia and who need support with their nursing and personal care needs. On the day of the inspection 23 people were living at the service. Manor Barn Nursing home is a large property with accommodation over two floors. There is a communal lounge, a communal dining room and enclosed garden.

We carried out the previous comprehensive inspection on 29 November 2016. The overall rating was requires improvement. We issued requirement notices in relation to the mental capacity act and the maintenance of records. Following the inspection, the provider sent us an action plan, telling us how they would make improvements and that the legal requirements would be completed by 31 March 2017. During this inspection, we found some improvements had been made but had continued concerns related to the mental capacity act, management of “as required” medicines and record keeping.

There was a new registered manager in post. 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 new manager had been registered with the Commission in September 2017.

People and their relatives told us staff were caring and kind. People told us they liked living at the service, were happy and would recommend the service to their friends. Staff demonstrated kindness and compassion for people through their conversations and interactions. People told us their privacy and dignity was promoted and they were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated. Relatives confirmed they felt their loved ones were safe.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process and to attend or contribute to care reviews where possible. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were personalised and guided staff to help people in the way they liked.

Risks associated with people’s care and living environment were effectively managed to ensure people’s freedom was promoted. People were supported by consistent staff to help meet their needs in the way they preferred. People’s independence was encouraged and staff helped people feel valued by engaging them in everyday tasks where they were able, for example laying the table and tidying their rooms if they wished. The registered manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken.

People’s medicines were mostly well managed. However, at the previous inspection in November 2016, it was noted that people did not have individual protocols in place in relation to ‘When required’ medication (also called ‘PRN’ drugs). These are medicines prescribed by GPs when a person has a short term or intermittent condition. These medications are not given as a regular daily dose or at specific times (e.g. during medication rounds) but given at the request of the person in accordance with their GP’s instructions. “PRN” medicines. Although PRN protocols were in place, these required greater detail. For example, some people were prescribed pain relief but there was not clear guidance in place on how individual pain should be assessed if people were unable to communicate, there was no guidance in place if the dose of the medicine was variable and the medicine sheets did not always record the time the medicine was given which was imp

The inspection took place on 29 November 2016 and was unannounced.

Manor Barn Nursing Home provides accommodation for up to 31 older people, some of whom are living with dementia and who need support with their nursing and personal care needs. On the day of our inspection there were 25 people living at the home. The home is a large property, spread over two floors, situated in Fishbourne, Chichester. There is a communal lounge, a dining room and a well maintained garden.

The management team consisted of a registered manager and a deputy 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.

People were asked their consent before being assisted and there were measures in place to ensure that people’s relatives had been involved in decisions about people’s care needs. However, practice and the lack of records confirmed that there was a lack of understanding in relation to the practical application of mental capacity assessments (MCA) and the deprivation of liberty safeguards (DoLS). Mental capacity assessments that had been completed were not decision specific and deemed a person not to have capacity simply due to the fact that they were living with dementia. Decisions for some people had been made by someone who was legally unable to make those decisions and best interest decisions had not always involved the relevant people. There was a potential lack of DoLS applications made and a DoLS authorisation that had been granted had not been renewed. The lack of understanding and practical implementation of the MCA and DoLS were areas of concern.

People had access to activities on certain days and records showed that people had enjoyed visits from external entertainers. However, observations showed that some people spent their day with very little stimulation or interaction from staff, other than when being supported with their basic care needs. Quality assurance audits were in place to ensure the delivery of good quality care, however, not all systems and processes were audited. For example, the auditing of care plans did not take place and the registered manager had not recognised that a DoLS authorisation had expired. Records were not always consistently maintained and showed that the recording of moving and positioning as well as food and fluid charts had not always been completed in their entirety. Guidelines for staff to follow in relation to ‘as and when required’ medicines had been devised but not implemented and therefore staff were not provided with sufficient information to enable them to know when to administer ‘as and when required’ medicines and as a result people may not have had access to medicines when they needed them or they may have been administered inconsistently.

People were protected from harm and abuse. There were sufficient levels of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. People were able to take risks in accordance with risk assessments that had been devised and implemented. People told us that they felt safe. People received their medicines from registered nurses; they had these on time and according to their preferences. There were safe systems in place for the storage, administration and disposal of medicines. One person told us, “I get forgetful so they give my tablets to me”. Another person told us, “They do it all. They do my blood sugar twice a day”. Infection prevention and control was maintained, the environment was clean and people told us that they were happy with the cleanliness of the home. A comment within a recent quality assurance questionnaire stated, ‘It is always clean, I appreciate tha

We considered the evidence we had gathered under the outcomes we inspected. We spoke with five people who use the service, four visitors, five members of staff and the deputy manager. We also looked at ten care plans and records related to the management of the service. Our inspection team was made up of one inspector. We used the evidence to answer five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

People told us that they felt safe. Safeguarding and whistleblowing procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the provider to maintain safe care. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At the time of inspection, no-one was subject to Deprivation of Liberty Safeguards.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that care plans reflected their current needs.

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

Is the service caring?

We spoke with five people who live at the home. We asked them for their experience about the staff that supported them. Feedback from people was positive, for example one person said, "I don't have anything negative to say. I enjoy living here". Another told us, "It's like a home from home. I can't fault it".

People who live at the home and their families were asked to complete a satisfaction survey by the provider. These were used to help improve the service in the future.

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?

The home worked well with other agencies and services to make sure people received care in a coherent way.

People knew how to make a complaint if they were unhappy. Complaints were dealt with in a timely and satisfactory manner.

People engaged in a range of activities both in the home and in the wider community.

Is the service well-led?

The service operated a quality assurance system which identified and addressed shortcomings. As a result, a good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

We spoke with six people living at Manor Barn Nursing Home during our visit. They were all satisfied with the service provided. One said, “The food is good and the staff are friendly”. Another told us, “The home is adequate, probably as good as any” and added, “The staff are all very good”.

We spoke with five members of staff and the manager. Staff told us that they enjoyed working in the home. One said, “This is the best home I’ve ever worked at, the residents are looked after as if they were our own family”. Another told us, “It’s a good team” and said, “We are able to have fun with the residents as well as doing our jobs correctly”.

We also spoke with three relatives and two friends of people who lived at the home. They were all complimentary about the home and staff. One said, “I’m very happy with the place, I think they do great jobs”. Another told us, “The staff are very good, they meet X’s (their relative's) needs”.

We found that the home was clean and bright and that people looked well cared for. People were offered choices about the care that they received and were provided with a good range of food and drink. Staff were welcoming and we saw that they supported people in a timely manner with kindness and respect. Everyone that we spoke with told us that they could approach the staff and manager if they were unhappy or had ideas to discuss.

We spoke with four people who lived at the home. They said they were happy with the care they received and felt safe living there. One person said, "All the staff are kind and helpful". Another person said, "I'm very, very happy here". We spoke with two relatives. One said, "It's such a nice place to be". The other said, "I think they really care".

We looked at the care records of three people who lived there. We found evidence that they had been involved in making decisions about their care. We also saw that care had been planned and delivered in line with people's individual needs and preferences.

We spoke with three members of staff who worked at the home. They said they liked working there and felt well supported and trained in their roles. We observed that they were kind and considerate in their interactions with the people who lived there.

When we looked around the home we saw that it was relaxed and friendly. We saw that there was a range of activities that people could get involved in.

The people we spoke with said they were confident they could approach staff with any complaints and that they would be resolved. One person said, "I feel I am listened to and that things will be addressed".