This inspection took place on 3 and 6 November 2017 and was unannounced. The inspection was carried out by two inspectors and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Manor Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing 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.

Manor Hall Nursing Home provides nursing and personal care for up to 44 people in one adapted building. There were 36 people living at the home at the time of the inspection. They had a range of complex health care needs which included people who have stroke and diabetes. Manor Hall Nursing Home also provides care and support for people who require end of life care. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care needs. Accommodation was provided over three floors with a passenger lift that provided level access to all parts of the home.

There is a registered manager at the home. 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 time of the inspection the registered manager was temporarily not working at the home. In her absence the deputy manager was responsible for the day to day running of the home with support from the operations director.

At our previous inspection in August 2016 we found the provider had not met the regulations in relation to ensuring there were enough staff deployed. People had not always received the care they wished for or required and people’s records were not always accurate or complete. The provider sent us an action plan and told us they would address these issues by November 2016. At this inspection we found improvements had been made and the provider was meeting the regulations. However, further time is required to ensure these improvements are fully embedded into practice.

There was a quality assurance system in place and this had identified the shortfalls we found. This was evident from the audits, meeting minutes and discussions with the director, deputy manager and staff. We had previously identified people’s records were not consistently person-centred and did not all include the information staff may require. Improvements had been made but further work was required to ensure this was fully embedded into practice. Work was also ongoing to ensure people were able to take part in activities they enjoyed and were meaningful.

Staff knew people really well. They had a good understanding of people’s individual needs and choices. They could tell us about people’s personal histories including their spiritual and cultural wishes. Each person was treated as an individual and their choices and rights were respected and upheld.

People were supported by staff who were kind and caring. Staff knew people well and had good relationships with them. Staff maintained people's privacy and understood the importance of confidentiality. Relatives were able to visit at any time, and were made to feel very welcome.

There were enough staff working to meet people's needs. Staff were deployed to ensure there was a good skill mix in each team. Staff were suitably trained and supported to deliver care in a way that responded to people's changing needs.

There was a range of risk assessments in place and staff had a good understanding of the risks associated with caring for people at the home.

The management and storage of medicines was

Manor Hall Nursing Home provides nursing and personal care for up to 44 people. There were 34 people living at the home at the time of the inspection. They had a range of complex health care needs which included people who have multiple sclerosis, stroke and diabetes. Some people had a degree of memory loss associated with their age and physical health conditions. Most people required help and support from two members of staff in relation to their mobility and personal care needs. Accommodation was provided over three floors with a passenger lift that provided level access to all parts of the home.

This was an unannounced inspection which meant the provider and staff did not know we were coming. It took place on 24 and 25 August 2016.

There is a registered manager at the home. 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.

There were not enough staff on duty to meet people’s needs. Staffing levels were based on the number of people living at the home. People’s individual needs had not been considered when determining staffing levels.

Staff had a good understanding of the risks associated with caring for people at the home and risk assessments were in place. Where people had health related conditions there was appropriate guidance in place which ensured people received the care they required. However, risks associated with managing people’s pressure areas and fire evacuation procedures required review. We made a recommendation about this.

People were supported by kind and caring staff. Staff knew people well and had good relationships with them. However, the delivery of care was task based rather than person centred. Care plans lacked information about people’s holistic needs. There was a lack of meaningful activities and people spent long periods of time isolated and unstimulated in the lounge. The quality assurance systems were in place but had not identified all the shortfalls we found.

Staff maintained people’s privacy and understood the importance of confidentiality.

Relatives were able to visit the home whenever they wished and were made to feel welcome.

The registered manager was aware of the Mental Capacity Act 2005 and DoLS and how to involve appropriate people, such as relatives and professionals, in the decision making process.

Relevant guidelines were available within the home for all staff to reference.

Staff received regular training and updates to enable them to meet people’s needs. Staff had regular supervision where they were able to discuss any concerns and identify any training or support needs.

People were supported to maintain good healthcare and were able to access healthcare professionals when needed. When people’s health needs changed the nurses ensured people were referred to the appropriate healthcare professionals. People were provided with a choice of food and drink that met their individual needs and preferences. This supported them to maintain a healthy diet.

The management and storage of medicines was safe, and people received their medicines as prescribed. Staff had received training on safeguarding adults and were confident they could recognise abuse and knew how to report it. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home.

There was a complaints policy in place. People told us they were happy to raise any concerns. People spoke highly of the registered manager. She was a visible presence at the home and knew people and staff well.

We used a number of different methods to help us understand the experiences of people using the service. We spoke to people living in the home who told us “It’s very nice here, I have no complaints and the meals are marvellous” and “I am absolutely delighted with the staff they fall over themselves to help you.” Relatives spoken with told us they had no concerns and that the care and staff were very good.

During our inspection we found that people had been involved in decisions about their care and chose how they spent their time. Care plans documented the needs of people and their preferences.

Safeguarding measures were in place to protect people living in the home. Staffing levels had been assessed and reviewed to maintain adequate staffing levels at all times.

A copy of the complaints procedure was displayed in the main reception, and in the homes statement of purpose. A complaints policy was in place. Evidence was seen that comments and complaints were documented, listened and responded to in a timely and appropriate manner.

People living in the home told us they were very happy with the care provided at Manor Hall. One person told us “Staff are excellent, they are concerned, good humoured and good at their craft”. We were also “The food is excellent, if I don’t like something they give me something different”.

The people we spoke to said that the home was very nice and they liked their rooms. They felt they were involved in decisions about the support and care they receive, they can decide how and where they spent their time and that the staff were very good. People said that the food was good, they were offered choices, special diets were catered for and staff provided assistance as required.