People’s experience of using this service:

The service had improved since our last inspection.

People’s medicines were managed safely and properly. Staff followed infection prevention and control guidelines. People received personalised care that was responsive to their needs and preferences. We received mixed feedback about staffing levels from people who used the service and staff. However, the service had used a dependency assessment tool to calculate staffing which showed staffing was sufficient. The registered manager confirmed they would keep this under close review. There were some areas identified within the home that did not meet infection control guidelines. The manager addressed this during our inspection. People had opportunity to access a range of activities including access to the local community. However, we received mixed feedback about activity provision. The activities coordinator had begun work to ensure the activities provided by the service met people’s individual needs.

We received positive feedback from people about The Manse Nursing Home. People told us it was safe and that staff were kind and treated people well. Staff understood the importance of providing person-centred care and treated everyone as individuals, respecting their abilities and promoting independence. People’s capacity to consent had been assessed in line with legal requirements. Staff had built positive caring relationships with people they supported and their families. Staff liaised with other health care professionals to ensure people's safety and meet their health needs. We received positive feedback about how the service was managed. The provider had auditing systems to ensure they met legal requirements.

More information is in the full report.

Rating at last inspection: Requires improvement (Report published 31 October 2017).

About the service: The Manse Nursing Home is registered to provide 24-hour care for up to 44 people. Bedrooms are located on the first and ground floors and all have ensuite facilities of a toilet and washbasin. Lounges and dining rooms are on the ground floor. The home is close to the centre of Kirkham with easy access to shops and local amenities. There are small gardens to the front and sides of the home, with patios and seating areas, accessible via ramps. At the time of our inspection, 36 people were living at the home.

Why we inspected: This inspection was a planned inspection based on the previous rating.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

This inspection took place on 07 August 2017 and was unannounced.

The Manse Nursing Home is registered to provide 24-hour care for up to 44 people. Bedrooms are located on the first and ground floors and all have ensuite facilities of a toilet and washbasin. Lounges and dining rooms are on the ground floor. The home is close to the centre of Kirkham with easy access to shops and local amenities. There are small gardens to the front and sides of the home, with patios and seating areas, accessible via ramps. At the time of our inspection visit, there were 41 people who lived at the home.

The service had 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.

At the last inspection in October 2016, we found the provider was not meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to safe care and treatment around medicines management. Following that inspection, the provider sent us an action plan which told us how they planned to make improvements for people who used the service. During this inspection, we checked to see what improvements had been made. We found the provider had made positive changes and the service was now meeting legal requirements.

We saw staff used safe systems when administering medicines. Medicines were safely and appropriately stored and secured safely when not in use. We checked how staff stored and stock checked controlled drugs. We noted this followed current National Institute for Health and Care Excellence (NICE) guidelines.

However, we found guidance for staff on the use of medicines prescribed for use ‘as and when required’ was not sufficiently detailed. We have made a recommendation about this.

The registered manager told us they observed medicines administration, but had not recorded any formal checks on staff competency. Following our inspection, we received assurances from the provider that checks on staff competency to administer medicines were being undertaken and recorded.

A range of audits and checks were available for the registered manager to use to assess, monitor and improve the service. However, these were not being completed as regularly as they should have been, due to a member of the management team being on extended leave from duty. This meant areas for improvement may not be identified and addressed in a timely manner. Following our inspection, we received assurances from the provider that quality assurance checks were now taking place as planned.

Environmental risks and risks to individuals were assessed and measures put in place to reduce or remove them, in order for care and support to be provided safely. Sufficient information was available to guide staff on how to support people safely.

We found staffing levels were regularly reviewed to ensure people were safe. There was an appropriate skill mix of staff to ensure the needs of people who lived at the home were met. Recruitment processes were used to ensure only suitable staff were employed to work with people who may be vulnerable.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

Staff had received safeguarding vulnerable adults training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

People told us they were involved in planning their care and had discussed and consented to their care. We found staff had an under

This inspection visit took place on 18 October 2016 and was unannounced.

At the last inspection on 30 May 2013 the service was meeting the requirements of the regulations that were inspected at that time.

The Manse Nursing Home can accommodate up to 43 people who require nursing or personal care. Bedrooms are located on the first and ground floors and all have ensuite facilities of a toilet and washbasin. Lounges and dining rooms are on the ground floor. The home is close to the centre of Kirkham with easy access to shops and local amenities. There are small gardens to the front and sides of the home, with patios and seating areas, accessible via ramps. At the time of our inspection visit there were 43 people who lived at the home.

There was a registered manager in place. 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.

We found the services medicines practices were unsafe. This was because we saw medicines were left unattended and out of sight of nursing staff and were accessible to anyone walking along the corridor. We also observed Medication Administration Records completed by nursing staff before they had given people their medicines. Records should only be signed for after medicines have been administered to confirm the person had received their medicines and to keep accurate records.

This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who lived at the home and their visitors told us staff who supported them were kind, caring, polite and professional in their approach to their work. Comments received included, “The staff are brilliant here. I only came in for a short stay and decided I didn’t want to go home.” And, “I am very happy with my care. The staff are very kind and pleasant. I have never seen a sulky face.”

One person who had recently moved into the home told us they had chosen the home because it had been known to them by reputation. The person said, “I have to say the home has met all my expectations. I have been amazed how easy it has been for me to settle in. I am being cared for by friendly and helpful staff.”

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us they felt safe because staff responded when they required their help. One person said, “As you can see I have my buzzer next to me if I need to call for help. They never keep you waiting.”

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked at the recruitment of three recently appointed staff members including one registered general nurse (RGN). We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

The service had checked when recruiting nurses that they were registered with the nursing and midwifery council (NMC). These checks had been repeated regularly to ensure nursing staff were still registered with the NMC and therefore able to practice as a registered nurse.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. St

People told us:

"I'm very happy here... I Know if I needed help I would get it...Everyone is treated with respect...They encourage independence with the things I can do and respect my privacy with things like the toilet."

"The cleaners are brilliant...Beds are changed every day and [Relative's] room is always spotless."

"If there was something wrong, I know I could speak with the matron...I'm confident they'd sort it out."

We found that people experienced care, treatment and support that met their needs and protected their rights. Needs assessment and person centred planning of care were of a good standard. People were happy with the activities at the home.

People who lived in the home were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. This included the use of appropriate policies and procedures and staff training.

People were protected from the risk of infection because appropriate guidance had been followed and people were cared for in a clean, hygienic environment. Staff were clear on their roles and responsibilities with regard to cleanliness and infection control.

People who lived in the home, their representatives and staff were asked for their views about their care and treatment and they were acted on. There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We were told staff were kind, helpful and always polite, with one person adding; “I have a laugh and joke with the cleaners.” Comments from others living at the home included; “I have everything I need.” “I am very happy here.” And “I have no complaints.”

Some people were unable to express their views about the standard of care they received. Relatives were extremely complimentary, telling us they were always kept informed of important changes and that they had confidence in the staff team. Comments from relatives included; “I don’t have any qualms about leaving her here.” And “the home is well managed.”

Relatives told us a high standard of nursing care was provided at The Manse.