Greathed Manor can accommodate up to 32 people. The service provides convalescence care, post-operative care, rehabilitation, respite care and palliative care. Facilities include single en-suite bedrooms, three lounges, a dining room, library and assisted bathrooms.

Greathed Manor 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.

The inspection took place on Wednesday 11 April 2018. It was unannounced.

The service was last inspected in January 2016 when it was rated good. No breaches of legal requirements were found. We made two recommendations about activities and the use of best practice in care planning. Improvements had been made. People nursed in their rooms had an extra member of staff to help them engage in activities and be less isolated. Care plans were linked with the nursing needs of people in line with Social Care Institute for Excellence (SCIE) and National Institute for Health and Clinical Excellence (NICE) guidance. This helped staff to understand the needs of the whole person.

There was no registered manager in post at the time of our inspection. The previous registered manager left and the current manager took up their post in February 2018. They had submitted an application for registration with the Care Quality Commission.

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.

A relative told us, “I have only good things to say [about the home]. It’s a lovely place to live. The atmosphere is very welcoming” and the staff are, “always friendly, always helpful.”

People stated that Greathed Manor was a safe place to live, and that staff did their utmost to ensure that anyone who entered the home was safe and secure. Relatives and people commented that there was a cosy, homely feel to the home, and that staff and management were welcoming and happy.

Medicines were managed safely and there were effective infection control procedures. We saw evidence that lessons had been learned when things had gone wrong by adopting procedures to prevent incidents happening again. Staff had a good understanding of safeguarding procedures.

One told us, “it’s about keeping people safe and protecting them from abuse.” There were enough staff on duty, and they interacted very well with people, visitors and each other in an appropriate manner.

People’s care plans took into account their wishes and preferences. People were provided with a choice of food and drink throughout the day and were supported to maintain their nutrition and hydration needs. The home was well adapted and designed to meet people’s individual needs. There were no locked doors or keypads. People had access to healthcare services and were receiving ongoing healthcare support.

We saw staff being caring and compassionate, treating people with dignity and respect. Staff knew people well and had a good understanding of them as individuals. Staff had received the training they needed to deliver care in a way that responded to people’s changing needs. Staff had regular supervision and appraisal.

Complaints were taken seriously by the manager and robust efforts made to resolve any outstanding issues.

People and staff praised the new manager for being approachable and always visible. One person told us, “She’s very nice, and I always see her around all of the time”. People told us that the manager had improved communication with staff, people and relatives. People told us that the manager listened to people when they had suggestions or if they had a problem. There was a lifestyle coo

Greathed Manor nursing home provides care and accommodation for up to 32 people. The home is a Grade 2 listed building. On the day of our inspection, 25 people were living in the home. Many people needed nursing care and/or were living with physical disabilities. Some people were living with dementia.

The inspection took place on the 27 January 2016 and was unannounced.

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 and their relatives gave positive feedback about the service they or their family member received. People were very happy. One person said “They really look after me here.”

People told us care staff treated them properly and they felt safe. One person said; “Yes, I have felt safe and I’ve never lost anything.” Staff had written information about risks to people and how to manage these in order to keep people safe. One person had been assessed as being at risk of skin breakdown, we saw a skin risk action plan detailing actions for staff to undertake to minimise the risk to the person which detailed the appropriate pressure mattress settings, repositioning schedules, and reference to nutrition care plans to promote skin healing.

Incidents and accidents were fully investigated by the registered manager, and actions put in place to reduce the risk to people of accidents happening again such as people falling.

People received their medicines as they were prescribed and when they needed them. Processes were in place in relation to the correct storage, disposal and auditing of people’s medicines.

People and their families had been included in planning and agreeing to the care provided. People had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed. The care plans for people did not show thoroughly their nursing needs as these were kept separately and we recommended that the plans were joined to provide continuity in both health and social care.

People were kept safe. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show if they were being harmed. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred.

Care was provided to people by a sufficient number of staff who were appropriately trained and deployed. People did not have to wait to be assisted. One person said; “I do think there are enough staff about.” Another person said “You never have to wait.”

Staff recruitment processes were robust and helped ensure the provider only employed suitable staff to care for people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When people lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Were they compliant with MCA, not clear here?

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. Related assessments and decisions had be

We carried out an unannounced comprehensive inspection of this service on 19 & 22 December 2014. Breaches of legal requirements were found. A warning notice was sent to the provider notifying them that they are failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 (the Regulated Activities Regulations 2010).

We undertook this focused inspection on the 13 March 2015 to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection of Greathed Manor Nursing Home by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Care plans did not reflect people’s current needs or individualised choices. Three out of the six we looked at had been reviewed since our comprehensive inspection but we did not see evidence of consistent best practice. This put people at risk of inconsistent care or not receiving the care and support they need. Assessments of people were not sufficient to make sure the care is planned to meet a person’s individual need.

Poor pressure area prevention care put people at risk of developing pressure wounds.

Improvements had been made to the legal framework around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff we spoke with did not always understand the requirements of the Act and how it affected their work on a day to day basis. The appointee manager had started to undertake the necessary MCA two stage assessment or applications to the local authority as required by the Deprivation of Liberty Safeguards (DoLs). This meant people without capacity were not consistently supported in agreeing to choices made about their care.

We spoke to several people who used the service during our visit. They told us that they liked living in the home and the staff were kind and caring. One person who used the service told us it was like living in a palace.

We saw staff interacted with people who used the service in a professional and caring manner, and addressed people respectfully. We observed that people who used the service were relaxed well cared for.

We saw that people's views were respected and they were involved in their care planning as much as possible. Risk assessments were in place to keep people safe without compromising their independence.

The home was clean and hygienic and well maintained. People who used the service told us they liked their bedrooms and enjoyed the lovely views of the open countryside.

Staff told us that they liked working in the home and felt they had sufficient training to undertake their roles. They told us that the staffing levels had improved but there was still room for improvement, particularly at weekends.

People who used the service and the staff felt supported by the new management structure in place.

People told us that they enjoyed living in the home and felt that they were well cared for. They told us that they had plenty of information available to them which helped them with their choice of home.

A relative told us that they looked at three homes before choosing Greathed Manor on behalf of their family member.

We had good feedback and comments regarding the food and the quality of the meals offered. People told us that there was a choice of menu and they could choose a lighter option if they wished.

We observed staff assisting people with dignity and respect.

The activity coordinator gave us an account of the activities available and we saw an art group in progress.

We noted that there were shortfalls with staff training and staff supervision. We also noted shortfalls with risk assessments.

A person who used the service told us that they had a lovely room, but they would like it to be cleaned daily.

People who use the service and their relatives said ‘the food is good, it’s always good’. Some people said that they liked the food here and could always have an alternative if they didn’t like what was on the menu.

People who use the service and their relatives said the home is always very clean, always smelt fresh and the staff were all good and cared for them or their relative well, and that their care needs were well catered for.

People who use the service told us they feel safe at the home, they like their rooms, it’s a beautiful building, and that they were happy at the home.

People told us how they could choose where to be around the home, could choose alternative meals if they didn’t like what was on the menu, that they were involved in choosing activities, and had no complaints, but knew how to make one if they did, and would feel free to do so.

Greathed Manor nursing home provides care and accommodation for up to 32 people. The home is a Grade 11 listed building. On the day of our inspection, 29 people were living in the home which included three couples. Many people needed nursing care and/or were living with physical disabilities. Some people were living with dementia. Greathed Manor service user guide states that they provide caring and professional process for those people that are terminally ill.

The inspection took place on the 19 and 22 December 2014 and was unannounced.

A registered manager was not 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. An appointee manager had been in post since August 2014.

People and their relatives gave mixed feedback about the service they or their family member received. Whilst some people were very happy, others were not. Our own observations, those of health care professionals and the records we looked at were not always in accordance with the positive views held by some people.

People’s safety had been compromised in a number of areas. For example, there was not enough staff employed or on duty to meet people’s needs. Staff did not have the specialist training they needed in order to keep up to date with best practices issues in the care of people at the end of their life. Poor pressure area prevention care put people at risk of developing pressure wounds.

Unsafe medicines storage and administration arrangements put people at risk of accessing medicines that were not prescribed to them.

Care plans did not reflect people’s current needs or individualised choices. They had not been reviewed on a regular basis. This put people at risk of inconsistent and /or not receiving the care and support they need. Assessments of people were not sufficient to make sure the care is planned to meet a person’s individual need.

The legal framework around the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards had not been followed. Staff we spoke with did not understand the requirements of the Act and how it affected their work on a day to day basis. The appointee manager had not completed close gap thee necessary MCA two stage assessment or applications to the local authority as required by the Deprivation of Liberty Safeguards (DoLs). Which meant people without capacity had not be supported in agreeing to choices made about their care.

The provider had not ensured there were the right mix of skills, competencies and experience of staff on duty each day to keep people safe.

Staff did not have the specialist training they needed in order to keep up to date with care for people who lived with epilepsy or needed support in end of life care. Staff did not demonstrate best practice in their approach to the care, treatment and support people received.

People were not being effectively supported with their nutrition or hydration needs. Some people were not supported in having regular drinks. This meant they may be at increased risk of becoming dehydrated.

People and their relatives told us that most staff members were caring and trying to do a good job. We observed some both good and poor examples of staff interaction with people throughout our inspection.

The provider did not always investigate record and tell people of the outcome of their complaint.

Some activities were available. We saw some people enjoyed an activity on the day of the inspection. However there were not enough activities provided for people specific to their needs.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, four of which correspond to regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.