The inspection took place on 28 November 2018 and was unannounced.

Manningford 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. The service accommodates seven people who are living with a diagnosis of mental ill health. At the time of our inspection there were four people living in the home.

At our last inspection on 19 January 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’ overall. There was no evidence or information from our inspection and ongoing monitoring which 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.

People continued to receive a safe service. Medicine administration records were completed by staff when they had administered the medicines safely. Risks associated with people’s needs had been assessed and measures were in place to reduce these. There were sufficient staff to meet people’s needs and safe recruitment procedures for staff were in place. Accidents and incidents were monitored to identify any trends and measures were put in place to reduce the likelihood of these happening again.

The service remained effective. Staff received the training and support they required including specialist training to meet people’s individual needs. People were supported with their nutritional needs. The staff worked well with external health care professionals. 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. The principles of the Mental Capacity Act (MCA) were followed.

People received care from staff who were kind, compassionate and treated them with dignity. They were comfortable in the presence of staff and the manager. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to support people when they were distressed and made sure emotional support was provided. People’s independence was promoted.

People continued to receive a responsive service. Their needs were assessed and their support was planned with them and or their relative where required. Staff knew and understood people’s needs well. People received opportunities to pursue their interests and hobbies, and social activities were offered. There was a complaints procedure available if this was needed.

The service remained well-led. The monitoring of service provision was effective because shortfalls had been identified and resolved. There was an open and transparent and person-centred culture with good leadership. People were asked to share their feedback about the service.

Further information is in the detailed findings below.

This inspection took place on 19 January 2016 and was unannounced. The previous inspection was in October 2013 where we found that regulations had been met. The home was registered to provide accommodation and personal care for seven people who may have mental health concerns. The home provides this service for women and at the time of visit they were supporting four women.

There was a registered manager in post but they were on leave at the time of the inspection. 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 were assisted to understand potential risks to their safety including abuse. Staff knew how to recognise signs of abuse and who to raise concerns with. Concerns were referred appropriately and investigated where necessary. Staff and the community mental health teams involved people in understanding risks to their health and well-being. They involved people in devising management plans to minimise the effects of those risks to try and keep them safe.

There were enough staff available for people to receive flexible support when it was needed. There were recruitment and induction processes in place to ensure new members of staff were suitable to support the people who were living in the home. People were happy with how staff supported them. Staff demonstrated skills and knowledge to the professionals that visited the home and when we spoke with them and this helped to ensure people were supported effectively and safely.

The registered manager and staff we spoke with were knowledgeable of the requirements of the Mental Capacity Act 2005. People living in the home had the capacity to understand and make decisions but at times would make unwise choices. Some decisions were made with people’s agreement or by other legal means to enhance people’s safety.

The home provided all meals to people who lived in the home except for five meals per week. People were provided with money to budget, buy and cook healthy meals as part of maintaining or developing independent life skills. People that needed to have advice about healthy eating in respect of their health conditions were offered this. Staff supported people to access to routine checks from health professionals to keep people physically and mentally as well as possible. In addition staff acted quickly and informed health professionals when there were changes to a person’s well-being.

People were receiving support from staff to talk about their relationships and their feelings when they wanted and this helped people feel cared for. Staff encouraged people to be involved with work and leisure activities as part of their progression to more independent living. In 2015 three people had moved to more independent living and this showed that their care and treatment had been successful.

The registered manager and staff provided calm, professional and person centred care for the people who lived in the home. Health and social care professionals told us that the management of home communicated well with them and followed any plans to support people. Staff told us they well supported by the management to provide appropriate care and to raise any concerns

There were systems in place for the registered manager to check the quality of the service day to day and to monitor for any trends in how the home was operating over a longer period.

We visited Manningford unannounced. During our inspection we observed and listened to how people who lived there were cared for. We spoke with four of the seven people who were living in the home. We also spoke with the manager and three care staff.

We observed that care staff supported people in a sensitive way. People confirmed that they felt safe and staff were caring. They told us: "I think staff would respond if I had any issues...," "Staff are helpful and support me to do more cooking for myself" and "Staff go out of their way to support you… they do not treat you as second class citizens." We observed good interactions between the whole staff team and people that lived in the home. A member of staff told us: "I am proud that we have helped three people to move on to independent living." Information was available about people's care needs and risks to their health well-being. People who lived in the home had the care and support they needed.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough staff with the qualifications skills and experience to ensure that people were supported and assisted appropriately.

Systems, policies and procedures were in place to lessen the risks to people that lived in the home.

We spoke with three people that lived in the home and looked at completed surveys from four people's relatives. They were all happy with the care that was given in the home. People told us they were happy that they got to see their relatives and were happy with the care staff supporting them. They told us that care staff available when they needed them and that care staff talked to them in a natural and friendly way. They said that were supported to be as independent as possible.

We looked at three people's care records and these provided good information about people's care needs and how these were going to be met. There was enough information for care staff to be able to identify when a person's physical and mental health needs were changing. People's care and health was reviewed regularly. People were assisted appropriately to receive their medication.

Where restrictions were in place to maintain a person or other people's safety this was in accordance with legal requirements.

People told us they were happy with the care and support they received and that it made a difference to their everyday lives. People told us that they were treated with respect and that care staff maintained their privacy and dignity.

During the inspection people who were using the service provided the following comments:

“I love it here, it’s really nice.”

“Food’s good, I sometimes help to cook.”

“You learn your independence. Staff coax you to do things and to go out but don’t force you.”

“Brilliant, I get on well with staff, I have no problems.”