CQC report explained · a residential care home
What the CQC found at The Manor Exminster
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People said they felt safe and there were enough staff. Inspectors found good risk assessments and safe medicines practice, but said some accident records lacked detail and some behaviour care plans needed clearer guidance.
- Effective?
- Good
- People's health and care needs were assessed and staff worked with health professionals. Training and support for staff were in place, although further training was planned on dementia, challenging behaviour and catheter care for newer staff.
- Caring?
- Good
- Staff treated people with dignity and respect and knew their histories, preferences and needs. People and relatives said staff were kind, caring and responsive.
- Responsive?
- Good
- Care was personalised and activities reflected people's interests and abilities. Complaints and concerns were listened to, and people who stayed in their rooms received regular visits and activities.
- Well-led?
- Good
- People, relatives and professionals reported improvements under the new leadership. The home used audits, staff meetings and an improvement plan, although the registered manager and deputy were still developing in their roles.
What inspectors found, May 2019
The Manor Exminster was rated Good; inspectors found caring, safe support, with some records and staff guidance needing improvement.
Inspectors visited without notice on 9 and 10 April 2019. They spoke with 10 people, six relatives, eight staff members and health and social care professionals. They observed care and checked care, medicine, staff and quality records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. People were described as receiving kind, respectful and personalised care. There were enough staff, medicines were managed safely, and people were supported to make choices and take part in activities.
The report also noted some areas to improve. Guidance for staff about responding to aggression or refused care was not detailed enough. Accident and incident records did not always contain enough information. The report said the home had improved after concerns raised in July 2018 and remained Good, the same rating as at the previous inspection in November 2016.
Kind and respectful care
Staff developed positive relationships with people and understood their life histories, likes and dislikes. People were supported with dignity, privacy and choice.
“People were supported by caring and compassionate staff who treated them with dignity and respect.” from the report
Staffing and safety
Inspectors found enough staff to meet people's needs. Staff responded to call bells promptly and used risk assessments to reduce risks such as falls.
“There were enough staff who worked flexibly to ensure people received care and support in a timely way.” from the report
Personalised activities
People could take part in varied activities, trips and community links. Staff and volunteers also visited people who chose to stay in their rooms.
“People were encouraged to socialise and pursue their interests and hobbies in a variety of creative ways.” from the report
Food and nutrition
People and relatives praised the food and choice. Staff involved people in menu planning and monitored those at risk of poor nutrition or dehydration.
“People and relatives all praised the quality and choice of food.” from the report
Improving leadership
Inspectors found improvements after earlier concerns, with audits, training and an improvement plan being used to monitor quality.
“People, relatives and professionals told us about improvements under the leadership of the new registered manager.” from the report
Behaviour care plans lacked detail
needs fixingSome care plans did not give staff enough guidance about managing verbal or physical aggression, or supporting people who refused necessary care. Further face-to-face training was being arranged.
“Challenging behaviour care plans needed more detailed guidance for staff about how to manage any verbal or physical aggression.” from the report
Accident records were incomplete
needs fixingThe new accident and incident recording system did not always capture what staff did immediately or what management did afterwards. Further staff training was planned.
“Reports captured in a newly introduced accident/incident reporting database lacked sufficient detail of accident or incidents.” from the report
Some training was still needed
minorFurther training was needed for newer staff in catheter care. Training was also being arranged on dementia and managing challenging behaviour.
“A health professional said catheter care had improved following training, although further training was needed for newer staff.” from the report
New leadership team
minorThe registered manager and deputy were relatively new and said they were still learning. They were undertaking management qualifications to develop their roles.
“The registered manager and their deputy were relatively new in role and described themselves as "still learning.” from the report
- 01How do you now make sure care plans give staff clear instructions about aggression or refusal of necessary care?
- 02What training have staff completed on dementia, challenging behaviour and catheter care, especially newer staff?
- 03How do you check that accident and incident records include immediate action and management follow-up?
- 04What improvements have been made since the safeguarding concerns raised in July 2018, and how are they monitored now?
This was an unannounced planned inspection covering the home, the care provided and all five CQC questions; all five ratings were given as Good. This explanation was written from the published report of 11 May 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2016
The Manor Exminster was rated Good; inspectors found safe, kind and personalised care, with further improvements still planned.
This was an unannounced follow-up inspection on 21 and 22 September 2016. Inspectors spoke with 14 people living at the home, five relatives, seven staff and four health professionals. They also reviewed care records, medicines, staffing, safety checks, accidents and quality systems.
The home had made significant improvements since the previous inspection. Inspectors found enough staff, safer medicines systems, better cleaning, improved care records and more personalised care. People were treated with dignity and respect, supported to make choices, and offered activities and help to stay connected with their community.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. There were no breaches of regulations at this inspection. The report says the warning notice issued after the previous inspection had been met.
Enough staff
Staffing levels and routines had been changed so staff could spend more time with people and respond at their pace.
“There were sufficient staff to keep people safe and meet their needs at a time and pace convenient for them.” from the report
Kind, personal care
Staff knew people's histories, preferences and communication needs. They treated people with dignity and responded quickly when someone was worried or needed help.
“Staff had developed positive caring and compassionate relationships with people. They knew each person well, treated them as an individual.” from the report
Good activities and community links
People were offered varied activities and support to continue hobbies, visit local places and remain part of the community. Volunteers spent time with people who were at risk of isolation.
“A weekly programme of activities provided lots of interest and stimulation for people.” from the report
Improved leadership
The report found a more open and welcoming culture. Staff felt supported, and the manager used audits, feedback and incident reviews to improve the home.
“The service had robust quality monitoring systems to monitor the quality of care people received and was making continuous improvements.” from the report
Improved records and nutrition
Electronic care records were more personalised and accurate. Staff monitored people's nutrition and hydration, and several people's health had improved.
“Significant improvements in care records and in standards of records keeping had been made following the introduction of electronic care records and staff training.” from the report
Staff vacancies remained
needs fixingAlthough the home had recruited many new staff, some vacancies remained. Gaps were covered by existing staff working extra shifts and agency staff when needed.
“Although there were still some vacancies, recruitment was underway and any gaps in staffing were addressed through existing staff working extra shifts and the use of agency staff where needed.” from the report
Further dementia-friendly work was unfinished
needs fixingWork was still continuing to make the building easier and safer for people living with dementia. This included signage, decoration, carpets and a secure outside area.
“There was further work ongoing to improve the environment of the home to make it more suitable to meet the needs of people living with dementia.” from the report
Some legal safeguard assessments were pending
needs fixingThe manager had made additional applications for people who might be deprived of their liberty, but the local authority had not yet completed the assessments.
“The registered manager had made several additional applications for people to the local authority DoLS assessment team for people living at the home, and were awaiting their assessment.” from the report
- 01Have all staff vacancies now been filled, and how often are agency staff used?
- 02What dementia-friendly building work has been completed since this inspection, including the signage, carpets and secure outside space?
- 03Have all outstanding Deprivation of Liberty Safeguards applications now been assessed?
- 04How are medicines records checked when signatures or stock numbers do not match?
- 05How will you make sure activities and community visits reflect my relative's interests and abilities?
This was an unannounced follow-up inspection checking improvements after the 2015 inspection and whether existing improvements were being sustained; it considered all five rating areas. This explanation was written from the published report of 12 November 2016 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of The Manor Exminster
3 rated inspections over 4 years: the service has improved, from Requires improvement to Good.
- May 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016Inspected but not ratedWell-led: Good
- November 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2014
Report published without a new overall rating.
- February 2014
Report published without a new overall rating.
- June 2013
Report published without a new overall rating.
- April 2013
Report published without a new overall rating.
- March 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 14 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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