Manor Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Families told us people’s care was exceptional. Staff had time to spend with people as well as provide exceptional wound care and enablement routines that were created by the on-site physio team and personalised to them. The management team worked collaboratively with the local authority and police to ensure any safeguarding concerns were dealt with appropriately. There was an exceptional approach to learning both through training and case studies undertaken by the staff team. Families and stakeholders told us they felt people were safe and staff are very skilled

This service scored 91 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We reviewed many case studies completed by staff that demonstrated their commitment to ensure the highest quality of care, for example people who had been admitted to the service with very deep wounds due to ulcers and the staff team have been able to nurse the wounds back to full health. Another example of a case study we reviewed was to ensure people at risk of weight loss consumed enough calories. The staff had identified not everyone could drink a full milkshake so worked with the kitchen staff to create a chocolate calorie boost shot to meet the needs of those most at risk of malnutrition. Risks to people's safety were assessed and reviewed. Care plans were linked with individual risk assessments which guided staff in providing safe care. A family member said, “Manor Lodge appears to be a very well run, friendly, homely, responsible & caring home. I would have no hesitation in recommending it to anyone. Any concerns we may have had, have always been taken on board seriously and dealt with efficiently & effectively. The management are extremely approachable and effective. I am informed immediately of any concerns.” Another relative said, “Some of the team have taken time to learn more about the condition and what things can be done to help support my relative.” There was a strong culture of recognising the importance of learning and embedding best practises.

A staff member said, “We are open to feedback and if we make a mistake, it is important we are open, hold our hands up and learn from it, learning is the most important aspect, and we have always stood for this.” The registered manager said, “We are proud to have achieved the Gold Standards Accreditation for end-of-life care, we have learnt a lot. We are very confident to talk to people about this now and we recognise the importance of discussing early so we can get people’s views rather than waiting.” The manager also said, “Sometimes things happen, but it’s what we learn and how we approach it. We have an open culture, and we ask families and staff never to go home unhappy, if they have concerns, they should come to us, we will listen, address and learn.”

Processes demonstrated people were consistently receiving exceptional care. There were systems in place to ensure staff fostered a culture of learning new skills to improve the lives of people. There were systems in place to ensure learning was identified from incidents and shared with staff. Learning was not just limited to the staff team. The registered manager told us that learning plays an important role in the residents and family meetings, where they have held workshops with families to help them learn more about the care, for example, modified diets, risk of choking and hydration. Staff recorded any accidents or incidents that occurred, and these were reviewed by senior staff to identify any action that could be taken to prevent a similar incident happening again. The management team told us they run daily reports to help identify if incidents have happened that they can learn from.

An example of excellent care, we read a thank you letter from a family member of someone who had stayed at Manor Lodge for rehabilitation. The letter detailed that two of the care homes physiotherapists had gone above and beyond by visiting the person’s own home to assess the suitability of the person’s home. They advised on equipment to make the environment safe. Families shared with us how the transition into the service had been made easier for them by the experience staff team. One family member said, “Staff were extremely helpful in assisting with the admission, I believe I was very close to a mental break down at the time and I was apprehensive as to what to do for the best. They simply listened to me, and just made the admission so simple and easy for me. I was totally transparent with them, and they were aware I was looking at other places, there was no heavy sales pitch, just empathy and compassion. Another family member said, “My [relative] has been a resident there for years in which time their needs have changed significantly. Initially [relative] was in the residential unit but the decline in physical and mental health led to them being moved to the nursing unit a couple of years ago. At all times I have felt that they are in a safe environment.”

The registered manager said, “We use weekly clinical reviews to ensure that we have not overlooked anything. We monitor changes in health through these reviews and ensure care plans and risk assessments are updated, families informed, and external referrals made when needed.” A professional stakeholder said, “If I was to have any issues that needed to be addressed, I would be more than comfortable to speak with the manager knowing that I would be listened to and my complaint dealt with swiftly.” Staff told us they have been given the opportunity to develop professionally through external training relevant to their role.

We received exceptional feedback from a medical professional who attends the service, they said, “Care is of the highest quality. The palliative care given is gold standard and they are very efficient at recognising deterioration of the residents and acting swiftly. The communication is of a very high standard, and I am always listened to and able to speak with the staff needed when I need to, whether that be through the telephone or face to face. We are always made aware of any changes to people’s health conditions. Care plans are updated regularly on the computer to enable staff to access this information quickly if needed.

Safe systems were in place to ensure people who attended short stays would be safe to be discharged. We saw evidence where the provider had gone above and beyond by visiting one person’s home to assess the environment to ensure it would be suitable and safe for them to mobilise around free from trip hazards. Robust systems were in place to ensure pre-assessments of new people to the care home were suitable. This ensured the provider could meet people's needs and provides the person and their family the opportunity to be involved in creating their care plan. There was also a unique approach to pre assessments that includes a physiotherapy assessment aimed at rebuilding mobility for all residents where appropriate. Processes were in place for staff to be able to identify changes in people’s needs and support them to move internally to higher dependency units if appropriate. Where healthcare professionals provided advice about people's care, this was incorporated into people's care plans and risk assessments. People’s care records contained documents which they could take with them to hospital or healthcare appointments. These documents contained important information about people’s care and communication needs, including personal details, the type of medication people were taking, and any pre-existing health conditions.

Families and relatives told us about the exceptional care relatives received which ensured their safety in the home. A supported person said, “I have lived here for many years. I would not want to be anywhere else. The staff are so kind.” Another person said, “I feel very safe here, and I am so well looked after. The staff are very kind and caring.” Families repeatably said, staff are well trained, and they feel more than confident to raise concerns. One relative said, “I do think that safety is paramount in what the staff do, I have no qualms about the safety of people and the staff.” Another said, “I feel that the residents are safe. My [relative] constantly walks up and down the corridors, but the staff always seem to know where [relative] is. It would be impossible to stop from walking, given their physical fitness. I think [relative] is monitored effectively. The care at Manor Lodge is impressive. There are always plenty of staff around and they are all constantly active in helping the residents.”

Stakeholders going into the home told us they feel people are safe and staff are knowledgeable. One professional stakeholder said, “I feel people are very safe, carers and staff are on hand day and night for assistance if and when needed for the residents.” A staff member said, “It is important for the person and their family the investigations undertaken properly.” Another said, “we would rather over report than under report, and if we report as a safeguarding, we automatically alert CQC with appropriate notification form.” The registered manager said, “We apply best practice by being open and honest and use safeguarding as an opportunity to learn. We are not afraid to talk about what has happened, sometimes it is about reinforcing what we already have in place. We just want to achieve the best outcomes for residents.” Staff we spoke to at all levels were knowledgeable about safeguarding, how to recognise signs of abuse and how to report.

We observed an exceptional dining experience where people were engaged with. Staff and people sat together enjoying the same foods. Staff had received dining with dignity training and demonstrated they really understood what they had learnt. People appeared relaxed and comfortable in the presence of staff. There was an engaging atmosphere with staff always on hand in communal areas. Staff were approachable and took time when speaking with people to ensure people felt listened to.

The registered manager and staff team showed great commitment to ensuring people were safe and any concerns raised were fully reviewed. Safeguarding concerns were investigated to the highest standard in a systematic and detailed manner, ensuring every single part of the allegation was responded to in detail. As part of their exceptional approach to safeguarding the registered manager was not afraid to report concerns to the police to ensure thoroughness and that nothing was missed. In addition to reviewing safeguarding concerns, the registered manager ensured systems and processes relating to any concerns were fully reviewed with staff to ensure potential lessons were learnt. The registered manager had logs and records that showed appropriate action had been taken where necessary. The management team have fully embedded a culture of safeguarding people through learning. There were many case studies that demonstrated the teams go above and beyond to assess, review and improve outcomes for people. This was not just limited to care needs but also included case studies on staff induction, communication and dining.

Many families consistently gave praise about the exceptional communication they have with the staff teams which ensures they are involved in the care and understanding risks and changes. One family member said, “The nursing staff are engaged and always happy to answer any questions about care. Staff call to touch base with me and discuss [relatives] care plan and ensure I am happy with how [relative] is being looked after. I am also given the option of a face to face catch up which I have taken up on a couple of occasions. I find the nursing staff proactive, engaging with other agencies such as Parkinson's nurses, mental health team and GP's as needs change. They take time to explain the reasons, any pros & cons and ask my opinion before a decision is made.” Families also shared that they find the family meetings very informative because there is a focus on sharing information and gave examples of learning about nutrition and hydration. There was a joint approach to many case studies undertaken, we reviewed the notes of one case study where music of a particular country had been identified with a family member as a possibility to improve their loved one’s emotional well-being and reduce moments of distress. This has now been added to the person’s care plan as an agreed way of supporting.

The feedback from staff was outstanding in their understanding of risk and management of it. There was a strong emphasis on promoting independence to reduce risk. The physio therapist employed by the provider said, “I work with people to fully assess their needs and their aspirations to regain mobility. I discuss the equipment with them and the pros and cons of different equipment. I have great connections within the community teams, so we have no issues waiting on equipment. We do everything we can to avoid people needing longer term hoisting. We live by ‘if we don’t promote them to use it, they will lose it’. We do all we can to reduce risk, and my aim, which is supported by management is to help people regain mobility to return home again. The best part of my job is seeing people improve independence and smile again.” Staff and the management team told us they worked together as a team to reduce the risks to people’s safety and well-being. Another staff member said, “if someone has a fall, we alert other staff to come help, we assess the person and the situation around them, we do not move them if we are concerned they are hurt, if they are hurt, we call emergency services. We make them as comfortable as we can with a blanket and a pillow. We need to pay attention that the person may not be able to communicate their pain so knowing them well is important. We carry out observation for 72 hours ensuring we check for pain, bruises, or any changes in the person. We also have protocols in place that mean we inform next of kin’s and complete our accident and incident reports.” Families told us they were very well informed of changes.

The providers processes to ensure communication and information sharing with families and people was exceptional. The team have robust systems that are fully embraced by families and the staff team to support knowledge and understanding of people’s health needs and the risks. Robust risk management systems were embedded into staff practice and the routines of the home. This supported staff in providing safe and effective care to people which had led to a reduction in the number of falls, the number of people at risk of malnutrition and incidents of distressed behaviour. Risks were identified and assessed at both an individual and a service wide level. Care records contained highly detailed risk assessments for people regarding the precautions people required to keep them safe such as the level of observation, support needs, signs of concern, medication reviews and how to communicate with the person. Daily meetings were held as well as weekly clinical reviews to review any arising concerns to enable action to minimise risks to be taken swiftly.

People lived in a safe environment; the home was extremely clean to an above usual standard. We were told there is an extensive plan in place for the new year that involves replacing a significant amount of water pipes that run the full length of the hall ceilings. Parts of this works had started, however the building needed for more extensive works. The provider had been very creative in reducing risk of trip hazards and taken an holistic approach to completing the works to reduce the impact on staff and people. This includes maintaining people’s dignity while the works take place and ensuring there will be showers and warm water stations available for use. The registered manager had met their legal obligation to inform CQC by way of statutory notifications about the water leaks. Given the circumstances the staff team were managing this situation extremely well. We received a higher than average number of feedback responses from families about the standards of care and treatment and no one mentioned the works as a concern or risk to their loved one. The risk assessment in place covered all aspects of concern with measures in place to mitigate risks to staff, visitors and people. People had access to the equipment they needed to maintain their mobility and safety, including hoists, slings and adaptations. We observed staff demonstrate safe practice when they supported people to mobilise. Regular checks and audits were carried out to ensure the home and equipment used in people’s care was safe. This included health and safety and fire safety checks.

People gave feedback on the care and treatment they received as outstanding. We were shown multiple thank you letters and feedback forms from service users who have received outstanding care to rebuild their mobility and learn to walk again. Some have been able to leave the care home setting and return back to their family home as a direct result of the care and treatment given to them. One person’s thank you note included, “Today I am overwhelmed to share I can walk again and with a renewed found confidence. When I first came to Manor Lodge, I was unable to stand long enough to take a step but with your gentle guidance, patience and encouragement to keep me motivated throughout my rehabilitation I can now walk.” A professional stakeholder said, “The treatment is first class. Both the residential and the nursing units seem to be well educated in the roles and their level of expertise shows through.” A family member said, “One thing they do particularly well is caring for individuals as individuals, nothing was too much trouble, this includes carers, nurses, the activity team, to the cleaners and hospitality staff. Care is amazing for residents and families a full holistic approach. They have details for the little things like making sure my [relatives] nails were painted, and lipstick was on. Supported people consistently told staff were and nothing was too much trouble.

We were told by a stakeholder from a medical background, “Having been working with the team, I can only say how incredible they are. They are an amazing team of people that clearly want the best for their residents and care deeply about providing the highest quality of care.” Staff told us about their dedication to end of life care and their ethos was about people being involved in the care and people’s right to die with dignity and their wishes respected. Staff told us it is important to them to be able to support families through the process as well as supporting each other and the person. One staff member said, “We provide a space for families to sleep, and we provide a comfort bag for families that includes a facecloth, toothbrush, toothpaste, body wash and shampoo among other items.” Another staff member told us there is a weekly mental health surgery for staff so they can support each other. All the staff we spoke to were proud of their work and the teams they are within. One staff member said, “I love working here, and I get pleasure out of knowing I am looking after the people.” Another said, “I love being involved with people, and making them happy. It’s the talking to the residents that I enjoy.” Another staff member said, “I read all the care plans, care plans are an important part of getting to know someone, I can then back this up by talking to the person and their family.” Another said, “I love working here, it’s so friendly and comfortable. Everyone gets on really well and the manager is open, and we can go to them for anything. I wouldn’t work anywhere else.”

All the staff we observed during our assessment seemed happy, smiling and there was a really good team feel. Staff approach was consistent across the units. We observed staff assisting people with mobility and using equipment in a gentle and sensitive way, people’s dignity was upheld, and it was clear staff were well trained. There was a calm atmosphere, people where relaxed and engaging well with staff. Where appropriate we noted dementia therapy dolls, fruits and snacks available, wine offered with lunch, chair-based exercise session and newspapers available. We observed that sufficient staff were available to meet people’s needs and keep them safe. People did not have to wait for care and support when they needed it. Staff engaged proactively and positively with people and were caring in their approach. Staff communicated effectively with one another to ensure people received the care they needed. Staff worked well together at lunchtime to provide a truly meaningful and engaging dining experience. For example, in one dining room we observed 6 staff sitting at different tables engaging in conversation with people. The care and treatment we observed was of the highest standard.

The provider goes the extra mile at Manor Lodge. For example, they employ a full-time physiotherapist and two assistant therapists who intern share their knowledge and expertise with other staff for better outcomes for those being supported. The provider has also encouraged and supported staff development through the accredited Gold Standard Framework to ensure staff have the skills and knowledge to support people through end of life care. Some staff have gone the extra mile to support their development and that of their colleagues also. For example, A family member told us staff have researched a person’s medical condition to be able to better support them. We were told another staff member has started to work with a hospice to further their understanding and share knowledge with the nursing team. Records showed that staff completed required training. Newly appointed care staff went through a comprehensive induction period. This included training for their role, shadowing an experienced member of staff and having their competencies assessed prior to working independently with people. People were protected against the employment of unsuitable staff because the provider followed safe recruitment practices. The provider used a dependency tool to calculate how many staff were needed on each shift to keep people safe and provide the care they needed. The dependency tool was reviewed regularly to ensure staffing levels continued to reflect people’s needs. Checks were carried out to ensure staff training and supervision was up to date, which ensured staff had access to the information and support they needed to provide safe and effective care. Team meetings were held regularly and were used to ensure staff worked in a consistent way and to provide updates on any changes in people’s needs.

Staff told us they attended training in infection prevention and control in their induction and regular refresher training. The registered manager described the measures that were in place to support best practice Infection prevention and control practices, this included monthly audits.

We observed the home was clean, hygienic and safe to an above usual standard. This included communal areas and people’s rooms.

The provider had systems in place to ensure people were protected from the risk of infection. Cleaning checklists were completed by the housekeeping team and audits of infection prevention and control were carried out regularly.

Staff told us where possible they discuss medicines with the individual person. We spoke with two people who confirmed that staff gained their consent before administration. They both confirmed that if there was any change or new medicines prescribed, they would be consulted with. One person confirmed that staff explained what a certain medication was for, which they were pleased about. Staff were able to explain the process to ensure medicines were handled, dispensed and destroyed safely when needed. Staff were able to explain best practice around covert medicines, and this was backed up by policy and GP authorisation where necessary. The management team along with the nursing team reviewed and monitored the use of antipsychotic medicines. A stakeholder shared with us, “Staff have been open to new processes that we have implemented by streamlining prescription management processes and improving working relationship between the care home and surgeries. Staff are confident to query any concerns regarding medication directly to the care home team and raise any concerns in a timely manner.”

Medicines were ordered, checked and available when people needed them. Medicines were stored, administered, recorded and disposed of safely. Staff were trained and assessed as competent to administer medicines. Robust processes were in place to ensure people received their medicines in line with their prescriptions. The pharmacist told us staff were skilled at identifying any concerns regarding medicines and would raise this promptly to look at what adjustments could be made. This supported people’s safety and well-being. Staff were confident and knowledgeable regarding the medicines they were administering and demonstrated a skilled approach in supporting people. We spot checked medicines against stock lists, we found no concerns.