Honiton Manor Nursing Home

The service is in the town of Honiton and is a detached period property. The home consists of two floors with a passenger lift providing access to each floor. There is a main communal lounge and dining area where people could spend their time as they chose. Improvements have been made so people had access to a safe outside area.

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

Systems in place safeguarded people from the risk of abuse and neglect.

People’s individual risks were assessed, managed, and monitored. Where improvements were needed these were acted upon.

Environmental risks were managed well which protected people from the risk of harm. A few areas for improvement were identified regarding fire safety at the home. The registered manager acted upon these promptly to ensure people would be safe in the event of a fire.

There were enough suitably trained staff to safely meet people’s needs. Staff were recruited safely.

Medicines were managed safely. Staff completed training in medicine administration and had their competency assessed.

Lessons were learnt when things went wrong. People were protected from the risk of infection, as the home had robust infection prevention control processes in place.

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 were positive about the care and support they received and told us staff were friendly, kind and knowledgeable about them and their support needs.

The registered manager and senior team ensured the service was homely, person centred, open and inclusive. They understood their responsibility to be open and honest with people and had acted when things went wrong.

Effective systems and processes were in place to continually improve and develop the quality of care provided.

People were kept informed and involved in developing the service. The management team worked well with the GP and health and social care partners to improve the care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 11 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and when the service was last inspected.

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.

Follow up

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

Honiton 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. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Honiton Manor provides accommodation with nursing care and support for up to 22 older people. There were 17 people using the service at the beginning of our inspection. The service is located in the town of Honiton and is a detached period property. The home consists of two floors with a passenger lift providing access to each floor. There is a main communal lounge and dining area where people could spend their time as they chose.

At our last comprehensive inspection in February 2017 the service was rated requires improvement overall. We issued the provider with two requirements. These were because the provider had not ensured all staff had received appropriate supervision and appraisal to enable them to carry out the duties they were employed to perform. They had not supported registered nurses employed at the service to demonstrate to their regulator that they continued to meet professional standards required in order to practice.

The provider did not also have systems and processes which were effective to ensure the safety of the service provided. At the last inspection, we asked the provider to take action to make improvements and this action had been completed. For example the registered manager had taken action to put in place systems to ensure all the registered nurses had received regular supervisions and appraisals. They had ensured nurses had training in the management of medicines and completed competency assessments on the nurses. The provider had decided during the last inspection to have thermostatic mixing valves (TMVs) on all hot water outlets accessible to vulnerable people. We received confirmation after the inspection from the registered manager that TMV’s had been fitted. Hot water temperatures were checked weekly to ensure people were not at risk of scalding and actions taken if concerns were found. Relevant information from people’s archived care plans had been added to the new system and reflected people’s needs.

The service had a registered manager. A registered manager is a person who has registered with CQC 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. They led by example and was supported by a deputy manager. They both had a high level of expectation of the staff to deliver good quality care.

People said they felt safe and cared for in the home. There were sufficient, suitably qualified staff to meet people’s needs. The registered manager had been addressing staff sickness which had improved staff attendance. There were robust recruitment checks in place.

People were protected from the risks of abuse as staff understood and carried out what they needed to do when they identified a concern.

There was a safe system to ensure the safe management of medicines at the service. Medicines were administered by registered nurses who had been trained regarding medicine management and had their competency checked.

People’s needs and risks were assessed before they were first admitted to the home and these were reviewed on a regular basis and when a change in their needs was identified. There were environmental risk assessments which ensured the premises were safe.

Staff had the skills and knowledge to support people appropriately. They received regular supervision and appraisals to support them with their performance and future development. New staff undertook a thorough induction when they started working at the service. The registered manager undertook relevant professional registration checks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Capacity assessments were undertaken and best interest decisions were being recorded.

People were supported to have a balanced and variable diet. Where people had specific dietary requirements these were catered for.

People had access to health professionals. A GP undertook a weekly visit to the home on a Wednesday to support people. They said they had a good working relationship with the staff and the system worked well.

Staff were caring and kind. They treated people with respect and dignity. There was a friendly atmosphere at the home and a strong ethos from the registered manager and all staff regarding it being a family and people’s home.

There was a designated activity staff member to support people to engage in activities that they were interested in, on an individual and group basis.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the management team. There had been one complaint since our last inspection which had been responded to in line with the provider’s policy.

The registered manager had several assurance systems in place to assure themselves the service was running safely. They spoke regularly with the provider to keep them informed about the running of the service.

This inspection took place on 18, 27 and 28 February 2017. The first two days were unannounced and we arranged to go back on the third day to spend time with the registered manager and partners. We initially carried out a focussed inspection on 18 February 2017 to follow up on the findings of the previous inspection in August 2016 where we had found a breach of legal requirement. However because of concerns found at this inspection we changed the inspection to a comprehensive inspection.

The breach found at the August 2016 inspection related to people not being protected from unsafe and unsuitable premises. In particular, we highlighted scald risks from the hot water supply and windows on the first floor which were not restricted to prevent vulnerable people from the risk of falling out. Following the inspection we were sent an action plan which set out the actions the provider was going to take.

At this inspection we found the actions set out in the action plan had been taken regarding the concerns. However, the water temperature was still higher than the recommended temperature. The provider had followed their action plan by completing monthly room audits and fitting a temperature restrictor at the boiler. This had not been successful at keeping the water temperature at the recommended temperature. The registered manger was monitoring the water temperature each week and had found at times temperatures were above the recommended. The provider decided during the inspection to order thermostatic mixing valves (TMVs) and had arranged for a plumber to fit on all water outlets accessible to vulnerable people. We received confirmation after the inspection from the registered manager that TMV’s had been fitted to all hot water taps accessible to vulnerable people.

The service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager had taken on additional responsibilities since our last inspection. They were now the area manager for the provider and were supporting the manager at the provider’s other service. This had meant they had delegated some of their responsibilities to the deputy manager. The provider was planning for the deputy manager to apply to the Care Quality Commission (CQC) to be registered as joint registered manager of Honiton Manor. We discussed the delegated time allocated to the deputy manager to undertake these responsibilities.

Medicines were not always safely managed. On the first day of our visits we found the medicines room was not locked which meant medicines were not safely stored. We also observed poor administration techniques not in line with the provider’s medicine policy by one registered nurse. The medicine fridge was unlocked, advance recording of the temperature of the medicine trolley had been documented and a discrepancy in the recorded amount of one medicine. When we returned the medicine record was accurate. We were made aware of how the inaccuracy had occurred. We observed that on these days medicines were being safely administered and stored. The registered manager and partners were taking action in relation to the concerns we identified.

There were adequate staffing levels to meet people’s needs. People felt there were enough numbers of staff on duty and that staff responded to bells promptly. Care staff received regular training, supervision and appraisals. However the registered nurses at the service had not received formal supervisions and appraisals since 2014. They had received the provider’s mandatory training but had not had their competency assessed regarding medicine administration and training if required.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Care staff had received training and developed skills and knowledge to meet people’s needs. However, registered nurses had not had their competency assessed in relation to medicine administration and their understanding. This would enable the registered manager to ensure they were competent to administer medicines and arrange training where there were concerns.

Measures to manage risk were in place to protect people’s freedom in the least restrictive way.

Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate. Visitors were made welcome and kept informed.

Care plans were personalised and recognised people’s health needs. At the last inspection the staff were transferring information from the provider’s old care plan system onto a new one. At this inspection we raised concerns with the registered manager that information from the old system had not been transferred to the new care plans which were now in use. Therefore information regarding people’s behavioural and psychological needs was not easily accessible. However, care staff had guidance from bedroom care plans which contained a synopsis of people’s needs which was reviewed monthly.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed.

People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service.

The provider had a range of quality monitoring systems in place which were used to review and improve the service. However these had not identified areas of concern we identified. Where there were concerns or complaints, these were investigated and action taken. With the exception of the hot water the premises and equipment were managed to keep people safe.

There are breaches of regulation. You can see what action we have taken at the end of the report.

Honiton Manor Nursing Home offers accommodation with nursing care and support for up to 22 older people. There were 19 people using the service during our inspection.

There was a registered manager. 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 said they were happy to approach the registered manager if they had a concern and were confident that actions would be taken if required.

People were not protected from unsafe and unsuitable premises. In particular, we highlighted scald risks from the hot water supply and windows on the first floor which were not restricted to prevent people from the risk of falling out. During the inspection, the registered manager and provider took immediate steps to mitigate the risks of both the concerns regarding the hot water supply and the windows safety.

People were not protected by an effective system to assess and monitor the health and safety risks at the home. The provider had identified through their assessment process temperatures of hot taps in sinks in all rooms exceeded the Health and Safety Executive (HSE) recommended temperatures. However no action had been taken to ensure these posed no risk to people at the service. Since the inspection an electrician and heating engineer have visited and are providing quotes for the necessary work to be completed.

There were sufficient and suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary to ensure staffing levels were maintained. However this meant the registered manager had undertaken a lot of additional shifts which had meant they had to prioritise their managerial duties.

People’s needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective monitoring systems in place.

People could choose from a menu which was regularly reviewed and updated and took into account people’s choices and preferences. People were very positive about the food provided at the home. Staff were polite and respectful when supporting people who used the service. Staff supported people to maintain their dignity and were respectful of their privacy. People’s relatives and friends were able to visit without being unnecessarily restricted.

The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People had access to activities at the service and were encouraged to take part. Arrangements were in place for people who stayed in their rooms to have support to avoid social isolation.

Recruitment checks were carried out. New staff received a thorough induction that gave them the skills and confidence to carry out their role and responsibilities effectively. Staff received regular training and updates when required and several staff were undertaking higher level qualification in health and social care. The staff had a good knowledge of how to safeguard people from abuse.

We found one breach of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

We also spoke with three providers, the supporting manager, cook, activities co-ordinator, domestic, deputy manager and two care workers. People were cared for and had their needs assessed and reviewed so that they could be met in a personalised way. This included one to one meetings with people to ensure that they were happy with their care. The home was clean and odour free. There was on-going maintenance which was outlined in a maintenance programme to ensure that actions were completed in a timely way.

We found that Honiton Manor was meeting all five of the outcomes we inspected.

We saw that care and support was delivered in a kind and respectful way. People told us that their views were respected with comments like, 'It's nice, I'm having a lie-in today' and about the activities 'I'm not very good at sketching but I'll have a go. The staff are very supportive'.

When care was being planned, we saw that people were involved in making decisions about their care and treatment and activities of daily living. We saw that people were encouraged to be engaged in various activities or offered one to one time with staff and that people were able to make choices about how they spent their day.

Everyone we spoke with made positive comments about the running of the home and opportunities available to them. Records showed that the home regularly monitored the quality of the service including people's views, risks, care plans and audits. For example the recent quality assurance survey included comments such as 'The manager is one of the best' and 'It's a lovely, happy home'.