Rutland Manor Nursing Home

Rutland Manor Nursing Home is a residential care home providing personal and nursing care to up to 41 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 35 people using the service.

The service accommodates people in one adapted building over 2 floors. The ground floor has a lounge and dining area. A garden and enclosed patio were also available that people could access.

People’s experience of using this service and what we found

Relatives told us they felt the service was safe. Staff were recruited safely, and staffing levels met people’s needs. Medicines were managed safely and were administered by trained nurses. Infection prevention and control measures were found in place.

Assessments of people's needs had been carried out prior to people using the service. People were supported to eat and drink a balanced diet and had a choice of meals, snacks and drinks. Staff training was relevant and up to date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives consistently told us they were supported and treated well. People and their relatives had contributed to their care planning and staff promoted people’s independence and treated people with dignity and respect.

People's needs were regularly reviewed, and support was adjusted as required. The service employed activities staff, who provided meaningful activities to keep people stimulated, as well as reduce social isolation.

The management team were passionate about delivering positive experiences and outcomes for people. The provider and registered manager had a good oversight of the service through their structured schedule of audits which checked all aspects of the service. People and their relatives had opportunities to provide feedback on the service in various ways such as in meetings, through questionnaires and in person.

Rating at last inspection

The last rating for this service was good (published 27 June 2018)

Why we inspected

The inspection was prompted in part due to concerns received about the care and treatment of people. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Rutland Manor Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Rutland Manor Nursing Home 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.

Rutland Manor Nursing Home is registered to accommodate 41 people. At the time of our inspection 26 people were using the service. The service accommodates people in one adapted building over two floors. The ground floor has a lounge and dining area. A garden and enclosed patio were also available that people could access.

The service did not have a registered manager in post at the time of the inspection. 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 manager was in post and they had completed the process to register with us. At the time of the inspection they were awaiting their registration certificate.

Our last comprehensive inspection was undertaken on the 3 March 2017 and although the service was meeting the regulations that we checked, we identified improvements were needed. This was to ensure safeguarding procedures were followed consistently and that staff supported people consistently when they demonstrated behaviours that put themselves or others at risk. At the last inspection some staff did not feel they were supported effectively or worked well as a team in meeting people’s needs. We asked the provider to address this. At this inspection all areas for improvement had been addressed. The service continued to meet the regulations and was rated as good.

There was sufficient staff to support people and people told us they felt safe at the home. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were undertaken that identified risks to people’s health and safety and care plans directed staff on how to minimise these identified risks. Plans were in place to respond to emergencies; to ensure people were supported in accordance with their needs. People had the equipment they needed to enable staff to assist them safely and staff understood about people’s individual risks. The provider checked that equipment was regularly serviced to ensure it was safe to use.

Staff supported people to make their own decisions whenever possible and where people were unable to do this, decisions were made in their best interests. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to take part in activities to promote their wellbeing and their dignity and privacy was respected by the staff team. People were supported to maintain relationships and visitors were made welcome by staff.

There were processes in place for people and their relatives to express their views and opinions about the service provided and raise any concerns they had. People’s representatives felt the service was well managed and they were involved in reviews of care. Staff felt supported and confirmed they worked well as a team. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

This inspection took place on the 3 March 2017 and was unannounced. At our previous inspection on the 4 May 2016 the service was meeting the regulations however we asked the provider to make some improvements. This was because there were times during the day where additional staff support was needed to ensure people were supported in a timely way and supervised. Improvements were also needed to ensure informal complaints were addressed promptly and areas identified for improvement were addressed in a timely way. We saw that improvements had been made in these areas. At this inspection the service continued to meet the regulations that we checked but we identified that other improvements were needed.

Rutland Manor Nursing Home is registered to provide accommodation, personal care and nursing care for up to 41 older people including people living with dementia. There were 27 people using the service at the time of our inspection.

There was no 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 previous registered manager had deregistered in November 2016 and a new manager was recruited. However they had recently stepped down and were employed as the clinical lead at the time of this inspection. The operations manager confirmed they were in the process of advertising the registered manager’s post, in the interim the operations manager was overseeing the management of the service.

Some staff did not feel they were supported effectively or worked well as a team in meeting people’s needs. Improvements were needed in the guidance for staff when supporting people who may demonstrate behaviours that put themselves or others at risk. Safeguarding procedures had not been followed consistently by the management team.

People felt safe and staff understood their role in protecting them from the risk of harm. People received their medicines at the right time and medicines were managed safely. People were supported by staff who had the knowledge and skills to provide safe care and support and there was sufficient staff available to meet their identified needs. Checks were carried out prior to staff starting work to ensure their suitability to work with people

People were supported to eat and drink what they liked according to their dietary needs and preferences. Where concerns were identified, people received support from health care professionals to ensure their well-being was maintained. Health concerns were monitored and people received specialist health care intervention when this was needed.

Staff were kind and caring when supporting people and knew people’s likes and dislikes. There were regular reviews of people’s care to ensure it accurately reflected their needs.

People were supported to participate in social activities. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. The staff and management team made visitors feel welcome and were approachable.

Quality monitoring checks were completed by the provider and when needed action was taken to make improvements. The provider sought the opinions from people and their representatives to bring about changes. The provider understood their responsibilities around registration with us. People knew how to complain and we saw when complaints were made these were addressed.

Rutland Manor Nursing Home is registered to provide accommodation, personal care and nursing care for up to 41 older people including people living with dementia. There were 33 people using the service at the time of our inspection.

There was a registered manager in post at the time of our inspection. 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.

Although staff understood people’s needs and preferences and were responsive to them, we saw there were times during the day where additional staff support would have ensured that everyone was supported in a timely way and supervised as needed. People’s representatives knew how to raise a concern and formal complaints were responded to but the provider’s procedure was not followed when informal complaints were made.

There were systems in place to monitor the quality of the service. However there was not a proactive approach to implement the improvements required. This led to external monitoring teams raising concerns and identifying the improvements which had not been made swiftly to reduce the risk to people using the service.

We saw that staff treated people in a caring and respectful way. People were offered refreshments throughout the day and their nutritional needs were monitored and actions taken as needed, to promote their health and well-being needs. Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs.Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks.

Staff told us they felt supported by the management team and were provided with training to enhance their knowledge and understanding. People and their visitors told us the staff were able to meet their needs and felt safe with the support provided to them. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse. Recruitment checks were carried out prior to staff starting work to ensure their suitability to work and people were supported to take their medicine as and when needed.

Capacity assessments had been completed to show how people were supported to make decisions. When people were being unlawfully restricted this had been considered and applications had been made to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions. There were processes in place for people and their relatives to express their views and opinions about the service provided. People’s representatives were asked to express their views and be involved in decisions related to the planning of their care.

Our previous inspection visit in October 2013 found that the service was not obtaining people's consent to their care consistently or completing documentation for advanced decision making with regard to resuscitation in an emergency. We saw this had improved and people's representatives were now giving their consent to the care and treatment provided. We observed the care and support provided and saw this was offered in a timely manner.

Our previous visit in October 2013 found that there were occasions when the service did not have a sufficient number of staff to meet people's needs. We also received information in March 2014 that suggested there was an insufficient number of staff available and that they were working long hours. We found that an additional member of staff had been employed to cover the evening shift and staff rotas showed us staff were not working excessive hours. This meant the provider had taken action to ensure there were a sufficient number of staff to meet people's needs.

Several people's relatives told us they were not sure if they had ever been asked for their consent although most told us they were involved in discussions and reviews of their family member's care. We also saw consent was sought inconsistently on the care records we looked at. This meant there was the potential for a person using the service to have important decisions made about them without them or their relatives being fully informed.

We received mixed feedback about staffing and rotas we looked at confirmed that there were occasions when shifts were short of staff. This meant there was the potential for people's needs not to be met. The management told us they were addressing this by considering the introduction of an evening shift, although this was not yet operational.

The service had a clear complaints procedure and we saw that complaints were properly addressed.