About the service:

Wadhurst 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.

Wadhurst Manor accommodates 65 people in one adapted building. At the time of this inspection 46 people lived at the service. The building was purpose built with well-designed areas for people to enjoy dining experiences. There was access to pleasant outdoor spaces for people.

The home was laid out over three floors. The middle floor was called ‘memory lane.’ People who lived with dementia were supported there on two ‘units’ called; ‘Topaz’ and ‘Amber.’ On the top floor people were supported with lower level ‘residential’ assessed needs in five of the rooms.

People’s experience of using this service:

People continued to receive a service that provided ‘Good’ outcomes. People were happy with the care they received and enjoyed living at the service. One person told us, “This place [Wadhurst Manor] has been a saviour to me. I cannot fault them in anyway.”

People felt safe and told us that staff supported them to feel safe at Wadhurst Manor. Staff were trained to support people’s needs safely and understood how to raise safeguarding outside of the service should they need to. Staff told us they did not have any current concerns for people.

Risks to people and the wider environment were identified and managed to ensure people were safe. Safety measures such as window restrictors were used. Appropriate safety checks were completed to ensure that equipment was well maintained and safe for use.

Medicines continued to be managed safely and people received their medication as prescribed and ‘as required.’ People were supported to maintain their independence in their daily activities and choices and were facilitated to ‘self-medicate’ medicines when desired and assessed as safe to do so.

People were supported to have maximum choice and control of their lives. Staff aimed to support people in the least restrictive way possible; the policies and systems in the service supported this practice. Staff ensured that they asked people for their consent before they supported them with any activities of daily living.

Staff understood the principles of the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty safeguards [DoLS] procedures. The management team had notified us appropriately when DoLS applications had been authorised.

People were given enough to eat and drink to meet their nutritional needs, choices and preferences. People’s more complex nutritional needs were identified and met appropriately. For example, Malnutrition Universal Screening Tool [MUST] monitoring was used, and professionals were referred to without delay, when people needed support regarding identified risks of choking or malnutrition. Kitchen staff were fully aware of people’s individual dietary needs.

Activities were provided as groups or on a one to one basis and people said they enjoyed these and that staff positively encouraged them to join in when appropriate. There were links to the wider community and people and their relatives were invited to attend sessions and talks at the service regarding dementia care to enable this to be more understood and for people and their relatives to feel supported and informed.

Complaints were managed well, and people felt listened to. The new management team were proactively working to address any concerns or complaints raised.

The service was well-led by the new management team who worked well together. People said the management were friendly and approachable. One person said, “The manager is lovely she comes to see me." Another person told us, "The manager is very good to me she comes in to see me.” There was an open and transparent approach with the way the service was run. Staff were encouraged to voice their views which were

Wadhurst Manor provides nursing and personal care for up 65 people. Wadhurst Manor is owned by the organisation Barchester Healthcare Homes Limited. The service is purpose built and provides accommodation and facilities over three floors. The ground and second floor provides care for people whose main nursing needs are related to physical health needs. This includes people who have had a stroke or live with a chronic health condition like Multiple Sclerosis, Diabetes or Chronic Obstructive Airways Disease. The first floor provides nursing care for people who were living with a dementia and was called ‘Memory Lane’. Wadhurst Manor is able to provide end of life care and used community specialists to support them in this care.

The service had a registered manager in place. 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 this inspection 61 people were living in the service with 27 people living on Memory Lane. This inspection took place on 20 and 25 April 2016 and was unannounced.

At the last inspection undertaken on the 10 and 16 December 2014 we asked the provider to make improvements in relation to care plans and risk assessments to ensure sufficient guidance was provided to staff to provide effective and responsive care. This included the care for people who had lost weight. In addition further documentation was needed to demonstrate the use of bed rails was consented to and only used in the person’s best interest to keep them safe. The provider sent us an action plan stating they would have addressed all of these concerns by April 2015. At this inspection we found the provider was meeting these regulations.

The quality monitoring systems and organisational procedures need further development to ensure best practice in all areas. They need to ensure staff employed via agencies are fully competent in the roles they perform within the service and medicine records always supported best practice.

People were looked after by attentive staff who treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. All feedback received from people and their representatives were very positive about the care, the atmosphere in the service and the approach and openness of the staff and registered manager. Comments included, “It’s like paradise here,” “I have the freedom here to be independent, and “It’s a care home AND a home. I don’t feel programmed. I can always get someone if I need help.”

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff employed by the organisation were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people’s needs could be met in a timely and safe fashion. The registered nurses employed directly by the organisation attended additional training to update and ensure their nursing competency.

All People and relatives expressed positive views about their experiences of the home during the inspection. People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure was readily available for people to use.

Staff monitored people’s nutritional needs and responded to th

Our inspection team was made up of two inspectors. We received concerns about a lack of staff working in the home at night. In response we visited Wadhurst Manor at 10pm to assess the safety of night-time staffing levels.

Below is a summary of what we found. The summary describes the feedback we received, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Our inspection was triggered by concerns raised to the Local Authority and ourselves that there were not enough staff working on some night shifts. The provider informed us on the telephone that at night, the home was staffed by one nurse and four care staff. We found this was the case during our inspection. Our evidence however showed that staffing levels were not based on people's assessed needs. Our evidence highlighted that this number of staff was insufficient to meet the needs of people who currently lived at the home. We have set a compliance action that requires the home review their staffing levels and ensure that there are enough staff on duty at all times to meet people's needs.

We also found that there had been four occasions in the previous twelve days in which staffing levels at night were below the home's minimum level. This meant that people were placed at risk of unsafe or inappropriate care because there were not enough suitably skilled staff to support all them properly.

Our inspection team was made up of two adult social care inspectors and a pharmacist. We answered our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

We spoke with 13 people who used the service and three visiting relatives. During the inspection, we spoke with the operational manager, the deputy manager, two registered nurses, four care staff and a visiting professional.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Each person living at the home had their own care plan which gave detailed information on the level of care and support they required to maintain their safety.

People told us that they were happy with the care and support that they received.

Recruitment practices were safe. Staff had the knowledge, skills and understanding to deliver safe and effective care.

Staff we spoke with demonstrated an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The Care Quality Commission (CQC) is required by law to monitor the operations of Deprivation of Liberty Safeguards. We found that the home was making arrangements for people living with dementia to ensure that their freedom and liberty was not restricted.

Staffing levels were safe however we received mixed feedback from people who used the service about the number of staff available.

Is it effective?

Staff we spoke with clearly knew the people they were supporting and caring for. They were able to tell us about people and their support needs.

Care plans were personalised and included information on the person’s life history and identity. This allowed for staff to provide care that was personalised and individual to that person.

Systems were in place to monitor, assess and improve the quality of the service. Feedback was regularly obtained from people who used the service and their relatives.

Training records confirmed that staff had received the appropriate skills and knowledge to safely deliver care and support to people.

Is it caring?

Staff spoke with compassion and kindness for the people they supported.

Observations of care found that people were treated with dignity and respect.

People were wearing hearing aids, glasses and footwear of their choice. People had their hair neatly done and people were dressed in accordance to their individual preference and lifestyle choice.

The service employed a dedicated activities co-ordinator who organised daily events. We saw that people were encouraged to participate but could also request activities to engage with.

It is responsive?

There was a complaints policy and procedure in place if people or their representatives were unhappy, which was monitored by the provider.

People and staff told us that they felt happy and confident approaching staff with any concerns.

People had access to call bells and pendants to summon assistance. For people living with dementia, we saw that the home undertook hourly checks on people to monitor their health and wellbeing.

People were given the opportunity to express their views on the service provided and had a care review each year or sooner if required.

Is it well-led?

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Staff had the necessary knowledge, skills and experience to meet the needs of people at all times.

The service promoted communication with care staff and kept care staff informed of all changes within the service. Staff meetings were held and shift handovers were completed which enabled new staff members coming onto to shift to be given the necessary and key information required.

The service had a business continuity policy in place. This made sure that each service had a plan in place to deal with foreseeable emergencies. This would reduce the risk of people’s care being affected in the event of an emergency such as a fire.

We spoke to four people who used the service, three relatives, four members of staff and the manager. We looked at five care plans including those outlining complex needs. We found that people's needs were assessed and care and treatment was planned and delivered in line with their care plan. A person who used the service told us, "I like living here, the staff know how to treat me when I am not well". A relative stated, "The staff are caring and vigilant. They always ring me and involve me if anything happens".

We found that the service had an appropriate recruitment procedure in place. We observed care being given to people and found that that there were sufficient numbers of suitably qualified, skilled and experienced persons employed. One member of staff told us, "The residents are well cared for, no one is neglected, we see to each one properly". A person who used the service told us, "The care workers are always busy, but they are very caring and there are enough of them". Staff were supported and received appropriate induction, training, supervision and appraisal as well as opportunities for professional development. A staff member told us, "We get a lot of support when we need it".

We found that there were clear complaints procedure in place. The provider monitored the quality of the service that people received and took account of comments and complaints. Results from surveys were processed for performance auditing and identifying possible improvement.

People told us that they were always treated with respect and dignity. They told us how they were given choices about their daily life and were involved in planning their care. People described the home as ''a happy home'' and told us that it was a ''good place to live'' and that they “felt very safe in the home and could speak with the manager at any time if they had any concerns”.

Residents said that staff were ''nice, very caring and comforting'' and were generally always around when needed.

We inspected Wadhurst Manor on the 10 and 16 December 2014. Wadhurst Manor provides accommodation and nursing care for up to 65 people, who have nursing needs, including mobility needs, long term healthcare needs, diabetes, as well as those in all stages of dementia. There were 50 people living at the home on the days of our inspections.

The home was adapted to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building.

Accommodation was provided over three floors. The ground and top floor provided nursing care and support. The middle floor, known as Memory Lane, was specifically designed for people living with dementia. The environment was specific in helping people with memory and orientation problems.

Wadhurst Manor belongs to the large corporate organisation called Barchester Healthcare Limited. Barchester provide nursing care all over England and have several nursing homes within the local area.

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 and associated Regulations about how the service is run.

At the last inspection in August 2014, we asked the provider to make improvements to their staffing levels. This was because there were not enough staff to safely meet people’s care needs. An action plan was received from the provider which stated they would meet the legal requirements by 1 October 2014. At this inspection we found improvements had been made, but other areas for improvement were still identified.

People told us they felt safe and spoke highly of the care and support they received. However, we observed care practice which could potentially place people at risk. For people living with dementia, they were often seen sitting in communal areas with no staff interaction. This could place people at risk of un-witnessed falls due to not having staff around. We have asked the provider to make improvements in this area.

People’s needs had been assessed and care plans developed. However, care plans and risk assessments did not always contain sufficient guidance to enable staff to provide staff, effective and responsive care. Despite concerns with documentation, we saw that people consistently received the care they required, and staff members were clear on people’s individual healthcare and support needs but we have identified this as an area of practice that requires improvement.

Where people had bed rails in place, documentation did not confirm if they consented to the bed rails or if they were implemented in their best interest to keep them safe. We have asked the provider to make improvements in this area.

Everyone we spoke with was happy with the food provided and people were supported to eat and drink enough to meet their nutrition and hydration needs. However, we could not see what action had been taken when someone had suffered weight loss. We have identified this as an area that requires improvement.

Staff understood the needs of people and we saw care was provided with kindness and compassion. People were dressed in their own style and if they needed support, staff helped people to take a pride in their appearance and dress in their personal style. The home had a hair dresser and manicurist who visited the home on a regular basis.

People were treated with respect and dignity by staff. They were spoken with and supported in a sensitive, respectful and professional manner. We saw staff members always knocked on bedroom doors before entering. Staff understood the importance of monitoring people’s health and well-being on a daily basis. Staff worked closely with healthcare professionals and were responsive to people’s changing needs.

Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training schedules were kept up to date. Plans were in place to promote good practice and develop the knowledge and skills of staff.

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