We carried out an inspection of The Manor House Whickham on 19 and 20 October and 3 November 2016. The first day of the inspection was unannounced. We last inspected The Manor House Whickham in August 2014 and found the service was meeting the relevant regulations in force at that time.

The Manor House Whickham provides accommodation, nursing and personal care for up to 74 people, including people living with dementia. There were 68 people accommodated there on the day of our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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 told us they felt safe and were well cared for. Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately, which helped to keep people safe.

The accommodation provided was to a very high standard, with a variety of pleasantly decorated and well-furnished lounges and seating areas. The building was safe and well maintained. The property was purpose built and adaptations had been made and additional signage provided to improve safety and highlight potential hazards. Other risks associated with the building and working practices were assessed and steps taken to reduce the likelihood of harm occurring. The home was clean throughout.

We observed staff acted in a courteous, professional and safe manner when supporting people. Staffing levels were sufficient to safely meet people’s needs. The provider had a robust system to ensure new staff were subject to thorough recruitment checks.

Medicines, including topical medicines (creams applied to the skin) were safely managed.

As The Manor House Whickham is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the deputy manager was familiar with the processes involved in the application for a DoLS. Arrangements were in place to assess people’s mental capacity and to identify if decisions needed to be taken on behalf of a person in their best interests. People’s mental capacity was considered through relevant areas of care, such as with medicines and distressed behaviour. Where necessary, DoLS had been applied for. Staff routinely obtained people’s consent before providing care.

Staff had completed safety and care related training relevant to their role and the needs of people using the service. Further training was planned to ensure their skills and knowledge were up to date. Staff were well supported by their managers and other senior staff. Staff performance was assessed annually and objectives set for the year ahead.

People’s nutritional and hydration (eating and drinking) status was assessed and plans of care put in place where support was needed. People’s health needs were identified and external professionals involved if necessary. This ensured people’s general medical needs were met promptly. People were provided with assistance to access healthcare services.

Staff displayed an attentive, caring and supportive attitude. We observed staff interacted positively with people. We saw that staff treated people with respect and explained clearly to us how people’s privacy, dignity and confidentiality were maintained.

Activities were offered within the home on a group and one to one basis. Adaptations had been made to the home to provide a calm and comfortable environment for people living with dementia. Staff understood the needs of people and we saw care plans and associated documentation were clear and person centred.

People using the service and staff spoke well of the home’s managers and they felt the

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection carried out on 11 and 13 August 2014. Prior to this we visited the service in June 2013 and found a breach in regulation 20 (records). We revisited the service in October 2013 and found improvements had been made.

The Manor House Whickham is a nursing home providing care for up to 74 older people, some of whom live with dementia. At the time of our inspection there were 70 people living at the home.  

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe living at The Manor House Whickham. Staff told us they had all received training in safeguarding and if they had any concerns they would feel comfortable to raise them. Staff we spoke to were able to describe the action they would take.

The registered manager and senior staff were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had completed an assessment tool to assess who would require a DoLS following the recent Supreme Court judgement which redefined the definition of what constituted a deprivation of liberty. She was working with the local authority to process these DoLS applications.

We saw risk assessments were in place for individual identified risks, for example weight loss or supporting people with moving and handling. We noted that plans were detailed and contained information that would help staff support people and manage risks in an effective way.

People told us they felt there were enough staff available to support them. The registered manager told us they tried to recruit 10% over the staffing requirement so they could cover for annual leave and sickness with minimal disruption. Staff told us that if they weren’t able to get cover, they could use agency staff where needed.

People told us they enjoyed the meals at the home and they were always offered a choice. We saw the staff were attentive towards individuals at meal times and provided support wherever required. Staff were aware of the individuals who needed special diets. A chef was employed to advise on the nutritional content of the menus to ensure that meals were nutritionally balanced and suited people’s needs.

Staff told us they felt supported in their role and received sufficient training. We looked at the training records and noted training was available both electronically and face to face. Staff confirmed they received regular supervision and annual appraisals. Staff told us these sessions were helpful as they could use them as an opportunity to discuss any concerns.

Everyone we spoke to told us they were happy with the care they received. One person said, “I am extremely well looked after. I cannot think of anything I would change, everything is first class.”

Staff were able to describe the care and support they provided to people. They described to us ways they could support people and help them maintain their independence.

We saw that activities were arranged and these took into account people’s individual preferences and also the varying abilities of people that lived at the home. People and their relatives told us that where possible, the service encouraged people to continue the interests and activities they had prior to moving to the home.

No one we spoke to had raised any concerns or complaints but told us they felt confident that if there was anything they needed to discuss they could raise this and it would be actioned.

The staff were positive about the atmosphere in the home and the management. They all told us they felt supported in their role and the registered manager was always available for them to talk with. People and their relatives also commented on the open atmosphere within the home.

We saw the provider had a robust quality monitoring system in place which covered areas such as meetings, feedback and audits. The registered manager showed us the yearly calendar which identified when each area of the process was due. This helped to ensure that all areas of the service were reviewed regularly.

The provider had made progress to improve the quality of people's care records. In particular, we found people who used the service had been assessed appropriately for the risk of poor nutrition.

We found people's needs had been assessed and care plans developed to meet those needs. Staff described how they promoted people's independence and gave examples of activities people were involved in.

We found the provider used a recognised tool to assess people's risk of poor nutrition. We undertook observations over the lunchtime period and saw people were supported, to varying degrees, with their eating and drinking.

We found there were enough staff to meet people's needs. Family members commented staff had spent a lot of time getting to know people and were particularly observant to enable them to pick up on people’s needs quickly. One person commented “Staff are excellent and look after you well”.

People had opportunities to express their views about the care they received. The provider had a comprehensive system of audits in place to identify gaps in care delivery. People and their relatives said they were happy with the care they received. One person commented; “There are no problems at all in here.”

We found care records were not always accurate or fit for purpose. Care plan evaluations lacked sufficient detail to enable an understanding of action taken to respond to people's changing needs.

People who used the service were asked how they felt about living at the home and the staff who looked after them. Their comments included “absolutely fantastic” “I love it here,” and “they treat me lovely.”

Relatives told us they were “happy with the care” and individual members of staff were singled out as “very helpful.”

Members of staff were positive about the home and said it was a “fantastic” place to work.

We observed people living in the home were encouraged to voice their opinions and be involved in how their individual care was provided. Family members commented that the home was an “amazing place”, told us “it’s like an extension of the family” and said they were “incredibly, pleasantly surprised”.

The people we talked with told us about how they maintained or developed their life skills. All of the people we met spoke very highly of the staff team. Their comments included “staff are very capable and all are qualified” and "staff are all very good .

We found that staff had a good understanding of the medication procedure and all staff had completed safe handling of medicines training.

People who use the service told us they were happy with the care that staff provided. We saw that appropriate checks were undertaken before staff began work.

People told us that they were aware of the complaints system, understood how to complain if they were unhappy with their care and felt confident about complaining if they needed to.