About the service:

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.

This inspection took place on 28 July 2017 and was unannounced. When Manor Park Nursing Home was last inspected in November 2015 there were no breaches of the legal requirements identified.

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.

We inspected Manor Park Nursing Home on the 17th April 2014 to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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".

Some of the people who lived at the home were unable to fully express their views because of their dementia. We therefore spent time talking with staff and observing practices as well as talking with people who used the service.

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.

The home specialised in the care of people who had a dementia and some people were unable to fully express their views to us. People who were able to converse with us said that they were able to make choices about what time they got up, when they went to bed and how they spent their day. One person told us “you can please yourself. I like to go to bed early and the staff help me to do that.” Another person said “you can do what you like really.”

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.

The home specialised in the care of people who had a dementia. Many people we met were unable to fully express their views verbally. Therefore in addition to speaking with people who lived at the home we spent time observing care practices and looking at records. During the inspection we were also able to speak with six members of staff and two visitors.

People told us that they were able to choose what time they got up and when they went to bed. We observed that people moved freely around the majority of the communal areas. One person told us “It’s OK here, you can be yourself.”

We noted that the dining room and bedrooms were locked when not in use. Staff gave assurances that people were able to ask to go to their room at any time and we saw that one person chose to spend the day in their personal room.

There was limited information and signage in the home to promote independence or enable people to make choices.

There was a board displaying the date and day in a corridor but this was not easily accessible. There was no clock in the main lounge to assist people to orientate themselves to the time of day. There was limited signage in the home to support people to move around freely and find their way to different parts of the building. Some bedrooms had photographs on the door to help people locate their rooms but others just had numbers.

There was no activities programme meaning that people who lived at the home, and their visitors, were unable to plan their day around activities that they wished to take part in. One relative spoken with said “There’s not much going on but they have a singer about once a month.”

People who were able to express their views verbally said that they were happy with the care that they received at the home. One person told us “It’s very nice living here” another person said “I’m well looked after and the staff are nice.”

We saw that people were assisted by staff who had a good knowledge of each persons needs. We observed that staff always asked people if they were happy to be helped before they began to assist them.

People were clean and well dressed demonstrating that staff took time to assist with their personal care.

People who lived at the home appeared comfortable and relaxed with the staff who supported them. We observed that people did not wait for extended lengths of time for assistance. People told us “Staff are very nice, they help you a lot” and “Staff are very pleasant with people.” One visitor we spoke with said that they thought that there was always enough staff on duty.

The service users at Manor Park have varying degrees of cognitive impairment and dementia and some are at an advanced stage of this condition. However, a number of the service users were able to give us their views of care at the home and spoke very highly of their care. We were told that their rooms were very comfortable and clean and tidy. They were able to go to bed when they wished and get up also when they felt ready.

The service users told us that they enjoyed the food and that they had quite a lot of choice. They commented without prompting that the cook was “very nice” and made “wonderful” food.

Two service users were living at the home who had been neighbours in the past, and said that they “could not fault” the care they received, and were very happy to be living together at the home. They said that the staff were “very kind” and spent time with them and were “patient”.

All the service users looked well dressed and were able to freely move around the home and sit where they wanted in the four lounges available to them. The home was warm and in good decorative repair and service users rooms had been personalised where possible with private effects.

One area of moderate concern at the home was that staff were not observed washing their hands or using gel between caring activities for different for service users, such as dispensing drugs or assisting with eating. The home also does not yet have a set of infection control policies which would include the provision of sanitizing equipment that was appropriate for a home caring for service users with cognitive impairment.