We inspected this service on 15 and 16 November 2018. The inspection was unannounced.

At our previous inspection on the 18 September 2017 we found a breach of the regulations in Good governance. This was because not all risks were being identified and appropriately mitigated by the registered person.

Following the last inspection, the provider had completed an action plan to improve the key questions of ‘is the service safe, responsive and well-led?’ to at least good. They told us measures would be in place by 8 January 2018. During this inspection we found the measures had been put in place and there was a good standard of risk assessment with guidance for staff that was detailed and thorough about minimising the risks.

Ealing Manor Nursing Home provides nursing care for up to 33 older people and younger adults with a physical disability. It is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 32 people were living at the home.

There was an experienced 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.

During the last inspection we found that there were not sufficient activities for all people living in the home to enjoy. At this inspection we saw this had been addressed. There was evidence of varied activities and people who remained in bed had regular staff interaction throughout the day.

During this inspection we found that some records were not being kept in a robust manner for people’s ongoing safety. This was because there were not always weekly fire alarm check recordings that demonstrated the alarms had been tested and were in working order. In addition, deep cleaning of the premises were not recorded so their regularity and effectiveness could be evidenced during audits and checks.

There were some infection control and some medicines management issues that were identified during the inspection. These were addressed by the registered manager on the day of inspection.

There was a programme of redecoration and this had refreshed the look of the premises. However, some window restrictors and other implements had been removed during the redecoration work and had not been replaced. This was brought to the registered manager’s attention and they were replaced the same day.

People and their relatives described staff as caring and kind. We observed care was offered in a polite and respectful manner. People were supported to be as independent as possible by staff.

The registered manager and staff could recognise signs of abuse and reported concerns to the appropriate authorities. The registered manager held reflective meetings when errors had occurred to promote good practice and to help ensure mistakes did not reoccur.

Medicines were administered appropriately and although we identified a few minor errors the registered manager audited monthly and addressed any errors with the nursing staff.

Staffing levels were assessed by the registered manager who ensured there was a suitably skilled staff team. Staff absence was covered by known bank staff. Recruitment processes were safe as checks were undertaken to ensure staff were of good character before they were employed. Staff were provided with an induction and ongoing training to equip them to undertake their role.

The registered manager worked in line with the Mental Capacity Act 2005 and applied for authorisations to deprive people of their liberty appropriately when this was indicated and people lacked the capacity to decide about

This unannounced inspection took place on the 18 September 2017.

Ealing Manor Nursing Home provides nursing care for up to 33 older people and younger adults with a physical disability.

At the previous inspection in August 2015 they were rated ‘Good’. At this inspection we have rated the home ‘Requires improvement’. This is because we found that although people had individualised risk assessments to keep them safe, some risk assessments were not in place to fully ensure their safety. We brought this to the attention of the registered manager and provider and they ensured these were completed immediately.

In addition there was a lack of stimulating activities for people. We have made a recommendation for the provider to review the provision of person centred activities for both people who wished to attend planned activities and those remaining in their bedrooms.

The provider had quality assurance systems in place however these had not identified the concerns we found during our inspection. Therefore, we found a breach of the regulations with regard to good governance.

People and their relatives spoke very positively about the 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 was visible and active in the home and everyone we spoke with including staff found them approachable. People and their relatives described staff as caring. We saw some sensitive and gentle interactions between staff and people.

People’s support needs were assessed prior to admission to ensure the home could meet their needs and to ensure there were enough staff to provide a quality service. The staff team was well established and were familiar to people. The staff recruitment procedure was robust to ensure the safety of people who use the service.

People’s care plans contained their views and stated how they wished to be supported. Staff reviewed care plans on a regular basis. People were appropriately supported when they reached the end of their lives because the provider had suitable arrangements in place for this purpose..

People told us they felt safe living at the home and the registered manager had reported safeguarding adult concerns appropriately. Staff had received safeguarding adults training so they knew what to do if they suspected people were at risk of abuse.

Nursing staff administered people’s medicines and medicine administration records were completed without errors or omissions.

Staff had received infection control training and were provided with disposable protective equipment to help prevent cross infection.

The registered manager and provider understood their responsibilities under the Mental Capacity Act 2005 and applied for Deprivation of Liberty Safeguards appropriately. People were supported to make choices by staff who gained people’s consent before offering care. The policies and systems in the service supported this practice.

Staff received a thorough induction and appropriate training and support to undertake their role.

Staff supported people to access the appropriate health services in a timely manner. There was close liaison between the service and the palliative care team.

People were supported to eat a nutritious and healthy diet and remain hydrated.

People and staff said they felt comfortable in raising concerns and knew how to complain. Auditing and checks took place to ensure the quality of the service.

The service worked in partnership with health professionals and asked for feedback to monitor and assess the quality of the service provided so they could make any identified improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulati

During our inspection we spoke with four people who use the service, one relative and seven staff. People who use the service spoke positively about the support they received from the staff. They said the staff were caring and attentive to their needs. People also said they were able to spend their time as they wished, on their own or in the company of other people.

The staff conveyed an in-depth knowledge of each person's needs and how they liked to be supported. We saw the people who use the service and the staff had developed positive relationships with each other and there was good communication and a relaxed atmosphere within the home.

People were involved in identifying their preferences and wants. This was reflected in the support plans that detailed how people liked to live their life and how they were supported with this.

People were supported to maintain a balanced diet and were provided with a variety of foods that reflected the needs of people who use the service.

People received support for their needs from the service and from external health and social care professionals. Within the home they were supported by sufficient levels of staff, which was flexible to meet people's individual needs.

We spoke with five people using the service who told us they felt safe and well cared for in the home. Their comments included "A1, I can’t praise them enough. I couldn’t stay here if the staff weren’t so good” and “the staff are very good, they make sure I’m comfortable."

Staff supported people in a professional and friendly way. People were offered choices about the food they ate at lunchtime and whether they took part in activities during the day. People also told us they were involved in making decisions. One person told us "I choose to stay in my room. I can go to the lounge if I want but I’d rather stay here. Staff are always popping in to check on me” Another person said "the food is always very good and there’s always a choice."

We spoke with eight staff who were able to tell us about how they maintained people's dignity, respected their privacy and gave them choices. They told us there were always enough staff to care for people. Their comments included "I love working here. We work together to make sure people are looked after.” Another person said "we do all the training every year.” Staff we spoke with were aware of the risk of abuse and gave appropriate answers when we asked what they would do if they thought a person using the service was at risk.

The provider had arrangements in place to make sure people were cared for safely. Appropriate checks were carried out before new staff were appointed and complaints were responded to appropriately.

People that we spoke with told us that their privacy, dignity and independence were respected.

People told us that their care needs were being met at the home.

People told us that they felt safe living at the service and that they were able to raise any concerns if they needed to.

People told us that staff listen to them.

People told us that they are encouraged to give feedback about the quality of care provided.

Comments received included:

“It’s nice; the staff look after me kindly”.

“The staff explain what they are doing when they provide personal care”

“No complaints, we are very lucky here”.

“They look after me well”.

“The staff definitely treat me with respect”.

“The staff treat me well, I feel safe in every way, no one bothers me”.

“What impressed me the most was that the manager took us around the home; she knew what was going on with each person”.

The inspection took place on 18 and 19 June 2015 and was unannounced. The last inspection of the service was on 21 September 2013 and there were no breaches of Regulation identified.

Ealing Manor Nursing Home is a nursing home registered to provide accommodation, personal and nursing care for up to 33 older people with a range of nursing care needs including palliative care. At the time of our inspection there were 33 people living at the home.

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 and associated Regulations about how the service is run.

Staff had been trained in safeguarding and showed a good understanding of safeguarding procedures.

People had individual risk management plans to help them stay safe. Regular health and safety checks were carried out on the premises and on equipment used during care delivery.

People received their medicines from staff at the required times.

People told us there were enough staff available to give them the support they needed. Staffing levels were determined by people’s needs.

Staff were knowledgeable about how to meet people’s needs. Staff attended regular training to update their knowledge and skills.

The provider met the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to help ensure people’s rights were protected.

People’s nutritional needs had been assessed and where appropriate people received the support they needed to eat and drink sufficient amounts. People had input into their care from external healthcare professionals, as and when necessary.

Staff working in the home understood the needs of the people and we saw care was provided with kindness and compassion. People, their families and friends told us they were happy with their care. Staff were kind and compassionate towards people and formed positive and caring relationships with them.

People and others who were important to them were involved in making decisions about their care. Their views were listened to and used to plan their care and support.

End of life care was provided in line with people’s wishes and preferences. The service had achieved Beacon status for implementing the Gold Standards Framework for people receiving end of life care.

People’s needs were assessed and care plans were developed which set out how these should be met by staff. People received personalised care that was responsive to their needs.

People were supported to take part in activities and interests they enjoyed.

People and their relatives knew how to make a complaint if they needed to. Suitable arrangements were in place to deal with people’s concerns and complaints.

The culture in the home was open, inclusive and transparent. Staff were supported, felt valued and were listened to by the management team. The manager was experienced and worked alongside the staff. Staff said they felt well supported and were clear about their roles and responsibilities towards people living in the home. The manager carried out regular checks and audits to assess the quality of care people experienced and took action in response to areas needing improvement.