Guisborough 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. Guisborough Manor accommodates 65 people in one adapted building.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff knew how to keep people safe and reduce the risks of harm from occurring. Staff had completed training in safeguarding and understood their responsibilities to report any concerns.

There was a registered manager registered with us who had recently left the service. However, there was a new manager recruited to commence registration and a management team in place at the service.

Robust recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly. Medicines were managed safely and administered by staff trained for this role.

Staff received appropriate training and support to meet people’s individual needs.

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. People were supported to have enough to eat and drink and had access to healthcare professionals as and when this was needed.

People were supported by kind and respectful staff who valued people’s individuality and independence. We observed positive interactions between people and staff. People could make choices about how they wanted to be supported and staff treated them with dignity and respect. There was a welcoming and homely atmosphere at the service.

People received support which was person-centred and responsive to their needs. Person-centred is when people’s preferences are respected. Personalised care plans were in place which helped staff to know how people wished to be supported with daily living. People were involved in developing and reviewing their care plans and decisions about their care.

People were supported to take part in valued individualised activities including regular community outings and entertainment to engage people and prevent social isolation.

People spoke positively about the deputy manager and the wider management team. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.

There were systems in place for communicating with staff, people who used the service and their relatives to ensure they were fully informed via team meetings and newsletters.

Further information is in the detailed findings below.

We inspected Guisborough Manor Care Home on 7 and 10 June 2016. The first day of the inspection was unannounced which meant the staff and registered provider did not know we would be visiting. We informed the registered provider of the date of our second visit.

Guisborough Manor Care Home is purpose built and can accommodate up to 63 people. The service provides care and support to people who require personal care and care for people living with a dementia. There are two separate units. The ground floor accommodates people who require assistance with personal care. The first floor of the service provides accommodation for people living with a dementia. At the time of our inspection there was 60 people using the service.

A new manager had been recruited and had been in post since 11 April 2016. The new manager had submitted an application to become the registered manager on 9 June 2016. A registered manager is a person who is 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about the different types of abuse and what actions they would take if they suspected abuse was taking place. Safeguarding alerts had been made when needed.

Risk assessments were in place for people who needed them and where specific to people’s needs. However, some risk assessments required updating as they did not correspond with peoples current needs.

Emergency procedures were in place for staff to follow and personal emergency plans were in place for everyone. However, some of these were not up to date and did not identify peoples current needs in the event of an emergency.

Robust recruitment procedures were in place and appropriate checks had been made

There was sufficient staff on duty. People and relatives told us there was enough staff day and night to meet the needs of people who used the service. A dependency tool was used to determine safe staffing levels.

Medicines were managed appropriately. The service had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed to show when medicines had been administered and disposed of.

Required certificates in areas such as gas safety, electrical testing and hoist and wheelchair maintenance were in place.

Staff performance was monitored and recorded through a regular system of supervisions and appraisals. Staff had received up to date training to support them to carry out their roles safely and had completed an induction process with the provider.

People were supported to maintain their health through access to food and drink. Appropriate tools were used to monitor people’s weight and nutritional health. We could see that staff made referrals to health professionals when they became at risk of malnutrition or dehydration.

Staff demonstrated good knowledge and understanding of the requirement of the Mental Capacity Act 2005 and Deprivation of Liberties Safeguards. The manager had a system in place for recognising when DoLS applications needed to be made or reviewed. Best interest decisions were recorded in the care plans and included details of who was involved in the best interest decisions.

People were supported to maintain good health and had access to healthcare professionals and services when needed. People had regular visits from their own GP’s.

From our observations, staff demonstrated that they knew people’s needs very well and could provide the support that was needed.

People, and where appropriate their relatives, were actively involved in care planning and decision making; this was evident in signed care plans. Information on advocacy was available and st

During the inspection we spent time observing the interactions with staff and people who used the service. We spoke with five people who lived at Guisborough Manor Care Home and five relatives. We also spoke with the manager, deputy manager and a number of staff of different grades and roles.

All of the people we spoke with were very satisfied with the care they received. Comments included, "The staff are marvellous. They have the skill of knowing what to do when I need support.” “It is good here and I am getting the care that I need.”

Relatives we spoke with were extremely positive about the care and support provided. They said, “We are very satisfied, the manager and staff are all very approachable and keep us well informed.”

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for assistance. We saw that staff communicated well with people and explanations of care were given.

We found that people had care plans in place that were up to date and in the main reflected their care needs.

We also found that staff worked in collaboration with other health and social care professionals.

We found that effective systems were in place for the maintenance and servicing of the premise.

We found that people's needs were met by sufficient staff.

We spoke with four people who live at Guisborough Manor and had informal discussions with others throughout the day. Some of the people living at Guisborough Manor were unable to verbally communicate their views and experiences to us. We were able to observe people’s experiences of living in the home and their interactions with each other and the staff. We observed staff interacting with people, giving appropriate support and supervision. We saw staff engaging in a positive way with people and there was a lot of smiles and signs of wellbeing.

People told us they had a keyworker (named worker), and that they valued this relationship. Two people said their keyworkers had been changed and they were not too sure who their new keyworkers were. The deputy manager confirmed they would discuss this directly with the two people.

People spoke highly of the care provided to them at Guisborough Manor. In a discussion with two people, they said, "We have been well looked after, the staff are all good and yes, generally treated with respect and courtesy."

Another person said, "It is far, far better that I expected, they are so kind and friendly. Yes, there is the correct attitude, they knock on my room door even if it is wide open."

People said they felt involved in their care. One person said, "They always put down that I am very independent, which I am."

People confirmed that they were able to make their own day to day decisions and lifestyle choices. They confirmed they had menu choices, could choose to participate in activities or spend time in their rooms. We saw that people had daily papers delivered and could maintain contact with their friends and family.

We saw that there were opportunities for people to be involved in a range of social and recreational activities. The service employs an activities co-ordinator who we saw arranged in house activities as well as taking people out to local garden centres, for coffee and lunches. There were large screens on both units to show movies on and on the ground floor unit there was a pool table for people to use.