About the service:

Tenchley Manor Nursing Home is registered to provide accommodation and nursing care for up to 37 older people. At the time of our inspection, 29 people were living at the home. The home provides permanent placements and short-term breaks for older people with a variety of nursing and healthcare needs.

People’s experience of using this service:

• People received care and support that was safe. The provider continued to have a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding people.

• There were risk assessments in place to identify any risk to people and staff understood the actions to take to ensure people were safe. There were enough staff to support people with their daily living and activities.

• People received effective care and support. Staff demonstrated a clear 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.

• 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 in the service supported this practice.

• People received care from staff who were kind and caring. Staff respected people's privacy and dignity. Staff supported people to be fully involved in their care planning and reviews. People were supported to express an opinion about the care provided and the day to day running of the home.

• People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes. People were supported to access health care services and to see healthcare professionals when necessary.

• People were supported by a team that was well led. The registered manager demonstrated an open and positive approach to learning and development. Staff said the registered manager was open to suggestions and approachable.

• There were systems 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 complaints and learnt from the issues raised.

• The registered and deputy managers worked professionally with agencies outside of the service and ensured a transparent, honest and open approach to their work which was valued by others.

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

Rating at last inspection:

Good (report published on 4 November 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

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

The inspection took place on 3 and 13 October and was unannounced.

The last inspection took place in February 2015. As a result of this inspection, we found the provider in breach of a regulation relating to safe care and treatment and asked them to submit an action plan on how they would address this breach. An action plan was submitted by the provider which identified the steps that would be taken. At this inspection, we found that the provider and registered manager had taken appropriate action and the regulation had been met.

Tenchley Manor Nursing Home is registered to provide accommodation and nursing care for up to 37 older people. At the time of our inspection, 29 people were living at the home. The home provides permanent placements and short-term breaks for older people with a variety of nursing and healthcare needs. Tenchley Manor Nursing Home is a large detached house situated on the coast at Selsey with views across the Solent towards the Isle of Wight. Communal areas include a large sitting room incorporating library and dining areas, a kitchen area where people and their relatives can help themselves to hot or cold drinks and a separate sun lounge. The majority of rooms have en-suite facilities. The home has extensive gardens to the rear of the property with access to the beach beyond.

A registered manager was 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.

People were provided with safe care and treatment. Risks to people were identified, assessed and managed appropriately. There were sufficient numbers of staff on duty to keep people safe and meet their needs. The registered manager was in the process of recruiting new staff to fill staff vacancies and employed safe recruitment practices. Staff had been trained to recognise the signs of potential abuse and knew what action to take if they suspected abuse was taking place. Medicines were managed safely and administered by trained, registered nurses.

Staff were trained in a range of areas to care for people effectively. New staff followed the Care Certificate, a universally recognised qualification. Training was updated as needed and staff were encouraged to study for additional, external qualifications. Staff had regular supervision meetings with their line managers and attended team meetings. The requirements of legislation under the Mental Capacity Act 2005 were followed and staff had a good understanding of their responsibilities under this legislation and about Deprivation of Liberty Safeguards. People had sufficient to eat and drink and all spoke highly of the food on offer. Special diets were catered for and people were supported to maintain good health through access to a range of healthcare professionals and services. People’s rooms were personalised and tastefully decorated and furnished.

Staff knew people well and cared for them in a kind, caring and compassionate way. People were complimentary about the staff who looked after them. They were supported to express their views and to be involved in making decisions about their care. People were treated with dignity and respect and had the privacy they needed. At the end of their lives, people were supported to have a comfortable, dignified and pain-free death.

Care plans included detailed, comprehensive information about people, their personal histories, likes and dislikes and how they wished to be cared for. A programme of activities had been organised for people and people were also able to access the community, either through organised outings, with staff or relatives or independently. Complaints were managed in line with the provider’s policy.

People were involved in

Tenchley Manor Nursing Home is a privately owned service which provides nursing care and accommodation for up to 37 older people. The service offers short and long term placements, including respite care. At the time of our inspection there were 24 people living at the service.

There was a 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 inspection was unannounced and was carried out on 3 and 5 February 2015.

People told us they felt safe. However, during our inspection we found that risks had not always been identified, which could impact on people’s health and wellbeing.

There were enough staff to meet people’s needs. However, staff were not always supported in carrying out their duties to deliver care and treatment safely. The registered manager’s approach to supervision was inconsistent and essential training was not always refreshed in a timely manner. We have made a recommendation that the provider research and consider adopting the latest research in developing suitable arrangements to ensure that staff were supported in carrying out their duties.

The provider had a process in place to carry out appropriate checks in respect of the recruitment of new staff.

There were appropriate systems in place for the management of medicines. However, there was no guidance to support staff with the administration of ‘when required’ (PRN) medicine. People were also at risk of using topical creams after the ‘use by’ date. We have made a recommendation in respect of PRN guidelines and the management of topical creams.

People were supported to have enough to eat and drink. However, staff were inconsistent in their approach to completing food and fluid charts for people at risk of malnutrition.

Care plans were detailed and reviewed on a monthly basis. However, they did not always reflect people’s current needs. There was a structured approach to activities but this approach was not focussed on individuals and their needs.

The vision and values of the providers are set out in the service user’s guide, which was available to people in their bedrooms rooms. There was an opportunity for people and their relatives to become involved in developing the service. A suggestion box was available on the desk in reception for use by people, their families, visitors and staff.

The audits undertaken by the manager and the providers to monitor the quality of the service provided were not robust and did not ensure the service continually improved.

Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns.

The Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), which applies to care services. Staff were guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests. We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards.

Healthcare professionals such as GPs, chiropodists and Speech and language therapists were involved in people’s care where necessary.

People and their relatives had been involved in the planning and review of their care. Staff used the information contained in the person’s care plan to ensure they were aware of people’s needs. They understood the importance of respecting people’s choice, privacy and dignity. People were encouraged to maintain their family relationships.

Staff had a good knowledge of people, had developed strong friendly relationships with them and were responsive to their needs. Staff interacted with people in a positive and supportive way.

The service was clean and appropriately maintained. All of the bedrooms were individualised and personalised with people’s personal effects. People using the service appeared happy and were relaxed in the company of staff.

People and visiting relatives told us they felt the service was well-led and were positive about the registered manager and the senior nursing team. The provider sought feedback from people or their families and there were arrangements in place to deal with complaints. Accidents and incidents were monitored and remedial actions identified to reduce the risk of reoccurrence.

There were arrangements in place to deal with foreseeable emergencies. A contingency plan had been prepared to ensure care was still provided in the event of disruption to the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.