We inspected Bathampton Manor on 17 and 18 April 2018. The inspection was unannounced.

Bathampton 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.

Bathampton Manor accommodates up to 21 people in one adapted building across three floors. People have single rooms, with some en-suite. At the time of our inspection there were 19 people living there. There is a choice of three communal spaces, a dining room and outdoor seating. The home is set in extensive landscaped grounds.

There was a 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 (HSCA) and associated Regulations about how the service is run.

At the last inspection we found two breaches of the HSCA in respect of person centred care and safe care and treatment. We asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) safe, effective, responsive and well-led to at least good. We found that the provider had not achieved this. Some improvements had been made, however these were not sufficient to meet the relevant requirements.

At our previous inspection in January 2017 we found people were not always protected from unsafe management of medicines. We also found this at the inspection in December 2015. At this inspection, we found people were still not always protected from unsafe use of medicines.

In January 2017 we found the provider did not ensure that people received person-centred care based on an assessment of their needs and preferences. At this inspection, we found that improvements had not been made and people’s care records did not contain assessments of some needs such as nutrition and skin care. People’s care records did not contain information about how they preferred their care to be delivered.

The provider did not always ensure people were supported in line with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Some people may not have had capacity to consent to treatment such as medicines, but best interest decisions had not been recorded to demonstrate the provider was acting lawfully.

The provider had systems in place to monitor the quality and effectiveness of the service. However these systems were ineffective and had not identified the shortfalls, particularly in respect of records, we found at our inspection.

People and their relatives were extremely complimentary about the quality of the care at Bathampton Manor. Many of the staff had worked at the service for several years and knew people, their needs and preferences well. The provider relied on this knowledge to maintain a high standard of personalised care. We observed warm and friendly relationships between staff and people living at the service. There was a range of activities delivered by both staff and external entertainers.

There was a clean, comfortable environment with a choice of communal areas. People could freely access the landscaped gardens.

The food was of good quality and people were encouraged to eat in the dining room.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 23 January 2017 and was unannounced. The last full inspection took place in November 2015 and, at that time, four breaches of the Health and Social Care (Regulated Activities) Regulations 2014 were found in relation to safe care and treatment, fit and proper persons employed, need for consent and good governance. These breaches were followed up as part of our inspection. The service was rated requires improvement.

Bathampton Manor provides accommodation for up to 21 people who need support with their personal care. There were 19 people living at the service at the time of our inspection.

There was a 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 registered manager told us that a new manager has been appointed. They will be taking over the responsibilities of the current registered manager. The registered manager told us they intend to de-register and the new manager will submit their registered manager’s application form.

At our last inspection we found people were not consistently protected by safe systems for managing their medicines. We found insufficient improvements had been made.

At our last inspection we found peoples’ rights were not upheld in accordance with the Mental Capacity Act (MCA) 2005. Although we found sufficient improvements had been made, this area of the service requires further development.

At our last inspection we found people were at risk of being cared for by staff who were not fit to work with vulnerable adults. At this inspection we found sufficient improvements had been made.

Although care plans contained risk assessments which had all been regularly reviewed, associated plans in place to inform staff how to reduce the risks to people were not always in place.

Staff were supported through an adequate training and supervision programme.

Staff in the main had a good awareness and understood their responsibilities with regard to safeguarding people from abuse. Appropriate arrangements were in place for reporting and reviewing accidents and incidents.

People’s nutrition and hydration needs were met. Staff demonstrated a good understanding of people’s needs and specific dietary requirements.

People and their relatives told us that staff were caring and respectful. People felt comfortable with the staff. People said they were treated with respect.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

People and their relatives spoke highly about the registered manager and the newly appointed manager. People were encouraged to provide feedback on their experience of the service to monitor the quality of service provided. People told us they felt listened to.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the second inspection that the provider of Bathampton Manor has not fully met all the regulations. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was carried out on 12 November 2015 and was unannounced. When the service was last inspected on 18 September 2013 there were no breaches of the legal requirements identified.

Bathampton Manor provides accommodation for up to 21 people who need support with their personal care. There were 18 people living at the home at the time of our inspection.

There was a 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.

Risks to people were assessed but there was a lack of monitoring which meant that people's safety was compromised.

Systems were not always being operated effectively to assess and monitor the quality and safety of the service provided. For example, we found unsecured windows on the first floor which meant people were at risk of falling from height.

People were at risk of being cared for by staff who were not fit to work with vulnerable adults. Staff recruitment procedures were not always robust because some checks had not been completed.

Medicines were not always managed or administered safely. Medicines were left for people to take at  a later time. There was no consideration given to the potential risk of other people taking the medicine.

People's rights were not always being well protected when they lacked the capacity to make some decisions.

Staffing levels were sufficient to ensure that people's care needs were met.

We have made a recommendation about the home's system for recording people's care.

The lunchtime meal service was a relaxed and enjoyable experience for people.

People were being treated with kindness, consideration and respect. People spoke positively about the care and support they received.

People were given the opportunity to provide feedback about the service. They completed questionnaires on an annual basis. Resident and relative meetings also took place and we found suggestions for improvements were acted upon.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The people who lived at Bathampton Manor told us that they were happy with the support they received. Comments included ''I can't say a bad word about this place'' and ''the staff are fantastic, all of them''. Evidence suggested that there had been an improvement regarding assessment of people's mental capacity and decisions around people's 'best interests' since our previous inspection.

We found that people's health and welfare needs were being met and the support they received was appropriate to their needs. We saw that people were being well treated and there were systems in place to protect them from possible abuse. There had been an improvement in medication management since our previous visit to the home and practice was safer.

Staff were found to be competent in their support of those living at Bathampton Manor and they received appropriate training and support in order to be able to meet people's needs. People were being asked about the service they received and the quality of the service was being monitored. We found that systems were in place to evaluate risks in order to meet people's health, welfare and safety needs.

We spoke with thirteen of the twenty people living at Bathampton Manor; three relatives; and a visiting health professional. Every person was very complimentary about Bathampton Manor, and no concerns were raised. One relative commented “when you walk in here it doesn’t feel like an institution, it feels like a home.” One person that lived at the service described how they “initially stayed for a month to try it, and no way would I leave.”

Staff described how they work together as a team, and a visiting health professional also commented on the effective leadership that existed in the home. There were sufficient staff on duty to meet people’s needs, and people described how staff were alert edto any deterioration in peoples’ health.

The home’s policy regarding mental capacity and how to include ‘best interests’ in decision-making was unclear, although people that spoke with us confirmed that staff were supportive.

Recording of medication administered to people using the service did not follow good practice guidelines, although people confirmed that they were happy for staff to manage their medication for them.

The home was observed to be very clean and people commented on the ‘homely’ atmosphere.

Feedback from quality assurance surveys was positive, and people using the service and those acting on their behalf, clearly felt that Bathampton Manor offered excellent care and services.

The people we met and talked to at the home said that they felt included when decisions were made about their care and welfare. They told us that the home organises residents’ meetings. People told us that they were able to discuss any issues or concerns that they may have at these meetings and that the manager listened and acted on what they told her.

People told us that the home provides a number of activities in which they could participate. Representatives from the local church visit the home to allow people to take Communion if they wish. Visits from representatives from other faiths can be arranged if required.

People told us that they were consulted about their care plans and that their families and/or friends were also consulted if that was relevant.

The people who use the service made a number of positive comments about the care and support that they receive. One person said, “it is a good place to live, staff do everything for me”, another comment made by a person at the home was “all the staff are so good to me”, we were also told by one person “it is a wonderful service, all the staff are so kind”.

People felt that they were able to be as independent as they wanted to be, but would be helped and cared for it their needs changed temporarily or permanently.

The majority of people who we met and talked to at the home said that the food they were served was “very good” and “excellent”. Some people told us that the food was average. One individual told us that the food was not as good as they would have cooked at home.

People told us that they have access to an optician, dentist, audiologist and chiropodist for those that wish to make use of these services.

People said that the staff were generally very kind to the service users and that they had not experienced any member of staff raising their voice or mistreating anyone. People told us that staff were “warm, happy and friendly” with them and each other.

People said that in their view the home was clean and tidy. They said their rooms were tidy and they were cleaned often, as were the communal areas. People stated that they had noticed staff washing their hands before and after attending to them.

All the people we spoke to stated that staff dealt with all aspects of their medication and that they relied on staff to give them the right tablets. People stated that they could self medicate if they wished.

People we spoke to during the visit stated that they felt that there were sufficient numbers of staff on duty at all times of the day.

One person told us that they see the manager a lot and she was “very kind”. We saw the manager talking to people who use the service, supporting them and talking to them in a warm manner. We noticed how comfortable people were to approach her and talk to her.