Gotton Manor Care Home is a care home for up to 60 people. The home provides nursing and personal care. It specialises in the care of older people, including people living with dementia. At the time of the inspection there were 38 people living at the home.

At the last inspection in January 2016, the service was rated Good.

At this inspection we found the service remained Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good;

Although people raised concerns about the staffing arrangements in the home, the provider was taking action to ensure vacant staff shifts were covered. There were systems in place to ensure suitable staff were recruited.

People were supported by staff who knew how to recognise and report abuse. Risks to people were identified and risk management plans were in place. Medicines were managed safely. Measures were in place to prevent the risk of the spread of infection. There were systems in place to record and review any accidents or incidents that occurred.

On the first day of the inspection our observations of the mealtime experience were mixed. People received a diet to meet their individual needs and we saw systems were in place to enable people to give their feedback regarding the menus.

People received effective care from staff who had the skills and knowledge to meet their needs. Although some staff in The Coach House had not received supervision in line with the providers policy, staff spoken with felt supported by their managers.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according to their individual needs.

People’s rights were protected because the correct procedures were followed where people lacked capacity to make specific decisions for themselves.

People were supported by staff who were kind and caring. Staff spoke positively about people; they demonstrated empathy and were able to tell us about people’s likes, dislikes and what was important to them.

People received care that was responsive to their needs and personalised to their wishes and preferences. People had access to a range of organised and informal activities which provided them with mental and social stimulation.

People could be confident that at the end of their lives they would be cared for with kindness and compassion and their comfort would be maintained.

There were procedures in place to manage complaints. Where complaints had been raised these were responded to and action was taken where required. The manager and provider treated complaints as an opportunity to learn and improve.

The provider had systems in place to monitor the quality of the service, seek people’s views and make on-going improvements.

Further information is in the detailed findings below.

At our last inspection on 12 October 2012 we issued compliance actions for four essential standards. This inspection was to follow up on areas of non compliance with the health and social care regulations. We spoke with five people who lived in the home and a visiting relative. We also observed the care provided to other people and spoke with 10 members of staff.

People said before they received any care or treatment they were asked if they consented and staff acted in accordance with their wishes. We were told “Staff always ask me what I want to do and respect my decisions”.

People told us “I think the girls looking after me are wonderful” and the activity co-ordinator was “Lovely. Since she came there are definitely more things going on”. A visiting relative said “I’m pleased with the care. They always phone me at home if anything is wrong”.

The provider had now taken steps to provide care in an environment that was suitably designed and adequately maintained. A staff member said “Everyone felt happier because the environment had improved. The refurbishments made them feel like the company cared about them”.

One person who lived in the home said “Staff are very good and mostly they come pretty quickly when you need them”. Another person said “Staff now spend more time talking with me”.

We found that quality monitoring systems were in place. Effective action had now been taken to address identified risks and areas of non compliance.

People we spoke with told us they were able to express their views, made choices and understood the care and support that was available to them. We were told “I am free to do what I please and can ask staff if I need anything” and “I attended the residents and relatives meeting where we discussed various things about the home”. We looked at the most recent relatives and residents meeting notes. These showed that concerns about staffing levels and the lack of activities for people had been raised by some of the relatives.

People said that there were sometimes delays before staff responded to their call bells. One person said “Staff sometimes come quickly but sometimes I can wait 10 minutes or more, which is a long time when you need to go to the toilet”. Another person said “Staff only have time to do their job and they don’t have time to chat. That’s what I miss more than anything”.

People told us that staff respected their privacy and dignity. We were told “Staff are polite and always knock on my door before coming in”. People said they were happy with the meals provided. We were told “We get lovely cooked meals. If anything they give us too much”.

We observed that the home required significant refurbishment and upgrade. There was a backlog of important maintenance work to be done on the building both internally and externally. We were told that remedial plans were in place but we did not see robust evidence to demonstrate that timely action had been taken.

We carried out an unannounced inspection to review the nursing home service and to check whether improvements had been made since our last inspection on 1 and 6 September 2011.

At the inspection in September 2011 we found that the residential home service (The Coach House) was meeting the essential standards of quality and safety. However, we had concerns about the nursing home service which was not compliant with four of the essential standards. Improvements were also needed to maintain compliance with two other essential standards.

At our last inspection we found that there were some inconsistencies in staff practices. Previously we were told that some of the male care staff were impolite and not very friendly. At this inspection we were told that this had improved. People told us, “I am happy for the male carers to look after me” and “I get on fine with the male carers”.

Throughout the day we observed that the staff were polite and respectful. We observed and heard much improved communications between staff and people who lived in the home. Staff regularly greeted people and engaged them in friendly conversations. For example, while supporting people with their lunch the staff engaged well with everyone including people who had difficulty communicating verbally. The staff were more visible and available when people needed assistance. The general atmosphere throughout the home was sociable, friendly and personal.

At our last inspection some people told us they had concerns about the time taken by staff to respond to call bells and a lack of activities for people to do. We also found that the needs of people with mental health issues were not sufficiently well understood. At this inspection we observed that the call bell rang much less frequently and when it did ring it was responded to quickly. One person told us, “It is a bit intermittent, sometimes the bells all go off together but mostly I don’t notice them. At night they dim the noise to make it less disturbing”.

A new activities coordinator had been appointed since our last visit. Several people told us that they had regular one to one discussions with the activities coordinator. Group activities were also taking place on the day of our inspection. We spoke with three people who sometimes displayed challenging behaviours. They were calm and relaxed and appeared to be a lot happier than when we last met them.

People’s bedrooms and communal areas, such as the dining room and the lounge, were all clean and tidy. A lot of refurbishment work had taken place since our last inspection. These works had improved the environment for people in the home and had aided the prevention and control of infection. However, some of the internal corridors as well as the outside fabric of the nursing home remained in poor decorative order. Management informed us that funding had already been earmarked by the company for further refurbishment works.

The home had recently appointed a new full-time manager. At this inspection we observed that they had an open management style. The new manager was visible throughout the home and was observed speaking with people and enquiring about their well being and their experiences of the service. One person said “The new manager is very friendly and down to earth. He’s the kind of person you could say anything you want to”. The new manager told us that they planned to have quarterly residents and relatives meetings as a forum to discuss issues and obtain people’s views on the service.

People told us they get up, washed and changed and go to bed to suit their preferences. One person said “It’s our choice we can do what we want”. We were told that staff respected their dignity and same sex staff assisted them with having showers “on the whole I’m quite happy here and I come and go as I please”.

Several people told us that their families and friends visited and took them out for walks and to attend social activities in the community. One person who had difficulty going out told us that they were regularly visited by their family and by the home’s activity coordinator “really and truly on the whole I am satisfied here”.

The majority of the people that we spoke with said that they were well looked after. People told us that overall the staff looked after their needs “I am well cared for” and “the staff are lovely”. People were particularly complimentary about their main carer, one person said “The staff are super and my carer is an absolute gem”.

But there were a few exceptions “most of the staff are really nice and helpful but some are not”. People told us “I am treated well regardless of whether or not I have visitors with me” and “nobody treats me badly”. However, there were some negative comments about one or two of the staff relating to their unfriendly manner. A couple of people told us they had difficulty understanding some of the staff “the staff are fine but I have problems with their accents”.

The majority of interactions between staff and people were respectful and supportive and staff actively engaged with people. However, we noted some examples of staff not engaging well with people on a personal level.

People said that the meals were good “We get lovely food” and “Sometimes there is too much food but I can ask for a snack if I prefer”. We observed lunch being served in both the residential and the nursing home dining rooms. People were relaxed and unhurried. Where necessary, staff assisted people with their meals and drinks.

Some of the people in the nursing home expressed concerns that there were delays of up to 15 minutes before staff responded to their call bells. We were told “I only ring when I really need help and delays can be very distressing” another person said “I am well looked after and staff usually come when I call but sometimes they are very busy”. Some people found the continual bell ringing disturbing.

We observed that the residential side of the care home was pleasant, clean and tidy throughout. We were told that it had been refurbished over the last 18 months. But the environment in the nursing side of the home was generally shabby and in need of decoration. Some areas of the nursing home were not as hygienic as they should be.

This inspection was unannounced and took place on 14 and 15 January 2016.

Gotton Manor is registered to provide care for people who require nursing or personal care. The home can accommodate up to 60 people. The home comprises of two separate but adjacent buildings. A nursing home service is provided in the main Manor House building and a residential home service is provided in the Coach House building. At the time of the inspection 44 people were living at the home, 22 in the Manor House and 22 in the Coach House.

The last inspection of the home was carried out on 2 April 2013 where the home was compliant. No concerns were identified with the care being provided to people at that inspection.

There is 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 registered manager was appropriately qualified and experienced to manage the home. They kept their skills up to date including their nursing registration. The registered manager had good support from the provider and further links with other home managers in their local area.

There were sufficient numbers of staff to support people safely and ensure people were not rushed with their care. There was a stable staff team who were kind and caring. Staff told us there was good team work and support from the registered manager and provider to do their job safely and effectively.

There was a happy relaxed atmosphere within the home, people were seen to be at the heart of the service. One visitor told us “the staff are all wonderful, they make our lives so much better with their caring ways”. There was constant interaction between people and staff and more than one person described living at Gotton Manor as a lovely home to live in.

People’s privacy was respected and all personal care was provided in private. People told us they were able to have visitors at any time. Each person who lived at the home had a single room where they were able to see personal or professional visitors in private. There were also numerous communal and private lounges for people to speak with their visitors.

A recruitment process ensured all staff were fully checked for their suitability to work at the home before they started work, this helped to minimise the risk of abuse to people. Staff knew how to recognise and report abuse and all were confident action would be taken to protect people if they raised any concerns.

Risks were identified and plans put in place to protect people from harm. For example, where a risk of a person falling from a bed had been identified, discussions had taken place to work in the person’s best interest to keep them safe with the least restrictive actions. This demonstrated an understanding and implementation of the Mental Capacity Act 2005 (MCA), and ensured that the least restrictive methods was used to manage any identified risks to keep people safe.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice guidelines. Medicines were stored, administered and recorded safely. The home arranged for people to see health care professionals according to their individual needs.

People were supported to maintain good links with outside health professionals and have access to other local services. On admission to the home people were offered a choice of three local general practitioner services. Local chiropodists visited the home on a regular basis. Aromatherapy and reflexology could be arranged through the home if people requested the service. A hairdresser visited the home weekly. One person informed us it made them feel nice to have their hair done every week.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. A number of people told us they enjoyed the food. Drinks and snacks were available to people and visitors to the home throughout the day. Kitchen staff informed us communication from the care and nursing teams regarding people’s dietary needs was very good. People who required special diets had the correct assessments in place from the appropriate health professionals.

People told us they were kept busy with a wide range of activities available for them. There were a number of photograph albums around the home for people to see the activities that had taken place in the home. Monthly newsletters were produced showing activities that had taken place and what the month’s activity programme was. On one of the days of the inspection people were seen to be enjoying a morning exercise programme, people were gently coaxed and encouraged to join in with reasons explained to them of the benefits of joining in with the exercise class.

There were quality assurance systems in place to enable the provider to monitor care and plan on-going improvements. People’s views and suggestions were sought to make sure changes were made in line with people’s wishes where appropriate. Complaints were taken seriously and people felt able to voice their concerns.