Saville Manor is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Saville Manor provides accommodation with nursing and personal care for up to 42 people. The home operates on four floors. At the time of our inspection 36 people were living in the home.

At the last comprehensive inspection in May 2017, the service was rated Good.

We received concerns about the care and treatment of a person who lived in the home and sustained a serious and unexplained injury in October 2018. At the time of our inspection, the police were investigating this incident.

Following the above incident, we carried out a focused inspection. We inspected the key questions: is the service safe? and is the service well-led? This report covers our findings in relation to those two key questions. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Saville Manor on our website at www.cqc.org.uk.

There was no registered manager in post. A manager had recently started in post. They had not yet submitted their application to register 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.

At this inspection we found the service was not consistently safe. Topical medicines were not always safely managed. Fluid thickening powders were not always stored or used in accordance with current NHS patient safety guidance. Pressure relieving equipment was not always used to provide optimum support and protection. Monitoring records were not always accurately completed to show that people had received sufficient fluids. Equipment such as hot surface temperature radiators were not used safely.

Staff had a good understanding of how to make sure people were supported and protected from the risks of abuse and avoidable harm. They had received safeguarding adults training and knew how to report concerns.

Staff had received moving and handling training and were clear about how to safely support people with walking aids and moving and handling equipment such as hoists.

There was no registered manager in post. A new home manager was in post and was planning to submit an application for registered manager with CQC.

Quality assurance systems did not always identify shortfalls and actions were not always taken when shortfalls had been identified.

At this inspection we found breaches in two 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.

The rating of the service has deteriorated to Requires Improvement in the safe and well-led domain. The overall rating for the service is now Requires Improvement.

Saville Manor is registered to provide nursing care for up to 42 people with enduring physical conditions or conditions resulting in physical disability. On the days of our visit there were 31 people living at the home. The visit took place on 30 and 31 May 2017 and was unannounced. We last inspected the home on October 2014 and no concerns were found at that time.

There was no registered manager for the service as they had very recently left. There was an acting manager in post. They had worked for the provider for a number of years. They were in the process of applying to be registered with us. 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 were safe and CQQ and the Local Authority had been informed of most of the relevant safeguarding concerns. However one recent allegation of poor practice had been dealt with by the provider internally. Action had been taken to keep people safe but the CQC and Local Authority had not been informed of the concern. The provider sent us information after our visit to explain how they had made this decision. However the nature of the concern meant it could be considered to be a safeguarding matter.

We have made a recommendation about staff training to ensure correct safeguarding reporting procedures are followed.

Staff were being supervised by the management and other senior staff. The provider had a clear supervision procedure in place that set out how this process was aimed at developing and supporting staff. However, supervision at the home had regularly been carried out in in a way that could be seen as negative towards the staff members being supervised. This could lead to staff not feeling motivated or valued in their work.

We have made a recommendation around staff supervision so that it is carried out in a way that is beneficial to staff and people at the home.

Risks to the safety and wellbeing of people were reduced because staff had completed safeguarding adults training, and knew how to identify the different types of abuse. Risk assessments were in place that identified the areas where the safety of people may have been at risk. Accidents and incidents were reviewed and actions taken to keep people safe. Trends were also identified to reduce the risk of reoccurrences. There were safe practices and procedures for the management of medicines in the home.

People told us they liked the food and we saw they were offered choices at each mealtime to help them decide what meal they wanted. People at the home and the staff had developed caring relationships. This was also the case with relatives and friends who spoke highly of the caring attitude of the staff.

Staff had an understanding of the needs of the people they supported and knew how to care for them in a way that met their needs. The staff we saw had a caring and attentive manner towards the people they supported who lived at the home. We saw that whenever possible, people were involved in making decisions about their care and support needs. People were offered discrete and sensitive assistance if they needed support to eat their meals or with intimate care.

When people had specific health needs and concerns there were arrangements in place for them to see their GP and other healthcare professionals. Staff closely monitored the health and well-being of people on an on-going basis. People were supported to consume the food and drinks they enjoyed and they were able to choose what they wanted. People were given discrete assistance if they needed support to eat their meals. The staff knew how to support people effectively and in a way that fully met their needs. The team of staff at the home were caring and supportive in manner

Saville Manor provides nursing care for up to 42 people with enduring physical conditions or conditions resulting in physical disability. On the day of our visit there were 40 people living at the home. The visit took place on 23 October 2014 and was unannounced.

We last inspected the home on 2 July 2013 and no concerns were found.

A registered manager had recently left the service after five years. There was a new manager who had been in post for three days when we visited who was not yet registered.  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 felt safe with the staff who supported them because they provided them with safe and suitable care. They were also helped to stay safe because staff were aware of how to recognise and respond to abuse in a way which would protect them.

The number of staff on duty at any time had been worked out based on how much support and care each person required. Five people we spoke with said there had been occasions recently when staff were extremely busy. However, we found there was enough staff to provide people with the assistance they needed.

There were positive and caring relationships between staff and people who lived in the home.  Where possible, people were involved in making decisions about how they were looked after. 

People’s privacy and dignity were maintained at all times. One person said they were; “very respected” by staff. Another comment was; “they are very good, very caring, in particular [name] is a very lovely member of staff”.

People said they were happy and enjoyed daily life at Saville Manor.  Comments included one person telling us; “I feel like a member of a big family”.  Another comment was; “I can well recommend the place”.

Our observations of the staff team interacting with people showed they were supported to lead meaningful lives.

We saw individual activities took place as well as group ones. Entertainers performed at the home regularly including a singer who performed for people on the day of our visit. We saw how much people living at the home appreciated the entertainment.

People were assisted by staff who were trained in their work to improve and develop their skills. Nurses were able to go on training courses to help them understand how to provide people with effective care and assistance.

The staff team had been led by a registered manager who left in September 2014. Based on our findings at the inspection we saw how the previous manager had been very much involved in the day to day running of the home. Clear leadership had been provided and the staff team had felt well supported. We met the new manager who had been in employment for three days .They spoke positively about the challenges of their new role.

There were quality checking systems in place which ensured the overall care and service people received was properly monitored and improved where needed.  

We spoke with fourteen people who used the service to find out what they thought of Saville Manor and the staff who worked there. We also met three people's relatives at the home.

People had positive views of Saville Manor. Examples of comments included, “if you have to go anywhere then this is the best place to be” and “it is a very good home and it takes you on and looks after you”.

Peoples were effectively assisted by the staff so that their range of nursing and care needs were met.

The majority of people felt satisfied with the meals that were provided with at the home. A small number of people felt that sometimes the food lacked flavour and was bland.

People were assisted by staff who were supervised to make sure they provided them with suitable care and support. The staff were able to obtain further qualifications and were trained in subjects relevant to peoples’ needs.

The quality of care and overall service people received was checked and monitored to make sure it was safe and suitable.

We visited Saville Manor Nursing Home on 30 August 2012 and spent the afternoon and early evening at the service. When we arrived we were greeted by the manager. We spoke with several members of staff on duty on the day of our visit.

Not all of the people we spoke with were able to tell us whether the care and support they received was to their satisfaction because of ill health. However, we talked with a number of people who were able to share their general views about the service and the staff who cared for them. We also met with family members of people who were living at the home.

People told us "Staff are very patient and kind. They are wonderful. It is very cosy and comfortable. We heard that "the staff are good. They are never rude. I get up when I want to and go to bed when I choose to “. A family member told us “I think it is a wonderful place. I like every thing I see. I could not speak more highly of it “

Staff told us they worked well as a team and new staff who had joined in the last few months had settled in well and taken to the role and the team quickly. Staff said they were well supported in their role and felt that they were able to provide safe and effective care.