This inspection took place on 29 and 30 August and 13 September 2017 and was unannounced. Manor Farm is a care home which provides nursing and residential care for up to 81 older people. At the time of this inspection there were 74 people using the service. The home is divided into three units spread across three floors, all accessible by lift. The top floor of the home is for people requiring residential care, the middle floor is for people with dementia and the ground floor is for people with nursing needs.

At the last inspection in May and June 2015, the service was rated Good overall but had one breach of the regulations because the provider had not had a registered manager for more than twelve months. 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. At this inspection we found this issue had been rectified. There was a registered manager in post.

People and relatives thought the service was safe. Staff were knowledgeable about how to report concerns or abuse. The provider had a recruitment system in place to ensure the suitability of staff working at the service and there were enough staff on duty to meet people’s needs. Risk assessments were carried out with management plans in place to enable people to receive safe care. The provider was in the process of carrying out refurbishment of the premises. There were systems in place to maintain the cleanliness and safety of the premises. The provider had systems in place to ensure the safe administration of medicines.

Staff received appropriate support through supervisions and training opportunities. Appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been applied for and authorised. Staff were aware of the need to obtain consent before delivering care.

People were offered varied and nutritious menus of food, snacks and drinks. People also had access to healthcare professionals as required to meet their day to day health needs.

People and relatives thought staff were caring. Staff were knowledgeable about how to develop caring relationships with people who used the service. People’s privacy and dignity was respected. Staff had awareness of The Equality Act 2010 and delivering care in a non-discriminatory way. People were given choices and their independence was encouraged.

Staff were knowledgeable about providing a personalised care service. Care plans were detailed and showed people’s preferences. A variety of activities were offered which included trips outside the home and visiting entertainers. People and relatives knew how to complain and the provider dealt with complaints in accordance with their policy. The provider kept a record of compliments about the service.

People, relatives and staff spoke positively about the management of the home. Regular meetings were held for people who used the service and relatives to check they were happy with the service provided. The provider had held a themed day to obtain feedback about the service. The service was asked to provide dementia training to the local community. Staff had regular meetings to keep them updated on policy changes, service development and to encourage good working practices. The provider had quality assurance systems in place to identify areas for improvement.

We have made two recommendations around the storage of medicines and supporting people with specific health conditions. Further information around this can be found in the detailed findings.

People we spoke with told us they felt they received good care which met their needs and requirements. One person we spoke with told us the care was "very good." another person told us they were "very happy here, no complaints." We found care and treatment was delivered in a way that protected people from harm and provided for their individual care needs.

People we spoke with told us they had enough food and drink to meet their needs. One person told us the food was "very good, very nice." Another person told us "On the whole, it (the food) is not bad." and "I can choose to eat plain food." We found people were protected from the risks of inadequate nutrition and dehydration because the provider had taken appropriate steps to provide people with nutritious food and drink.

People we spoke with told us they had enough equipment to meet their individual needs. One person told us "I have my chair and I can get about." We found there were sufficient supplies of equipment available to meet the needs of people who used the service.

There were enough qualified, skilled and experienced staff to meet people’s needs. People we spoke with told us they thought there were enough staff available to meet their needs. We found the service conducted a monthly dependency review sheet which assessed the number of residents and their dependency rating.

People we spoke with told us they were treated with respect and their privacy was maintained by staff. One relative we spoke with told us staff were "very respectful, they're doing a great job."

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with told us they received good care. One relative we spoke with told us "she used to fall a lot at home; but they are very caring."

People we spoke with told us "yes" when we asked if they felt safe. 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.

We found appropriate arrangements were in place in relation to the recording of medicine. Staff we spoke with told us they recorded when they administered people's medication.

People we spoke with who used the service told us they had no complaints about the service. They also knew who they could speak to if they did. For example one relative told us "no complaints, you go to the head person."

People who used the service told us they enjoyed living at Manor Farm Care Home " everything is straight forward" and "it's not too bad here". One person told us they were "very happy here, no complaints".

People told us they had choice about how they dressed and how they lived in their rooms. One person told us "I have my things the way I like".

During this inspection, people told us that they liked the staff, although they were very busy. People told us they liked the food provided in the home. People commented positively on standards of cleanliness.

Manor Farm is a residential and nursing home which provides nursing and personal care for up to 81 older people. At the time of this inspection there were 54 people using the service. The top floor of the home is for people requiring residential care, the middle floor is for people with dementia and the ground floor is for people with nursing needs.

We last inspected the home on 15, 16 and 17 September 2014. During this inspection we found breaches of three regulations. The provider had not ensured that there was enough equipment to promote the comfort, independence and safety of people using the service. There was also not enough qualified, skilled and experienced staff to meet people’s needs. The provider did not have an effective system in place to monitor call-bell response times, the performance of staff working at weekends or during the night and we saw no evidence that the provider carried out their own monitoring checks of the service.

We carried out this unannounced inspection on 28, 29 May, 3, 4 and 5 June 2015.

During the inspection we found people consistently received their medicines safely and as prescribed. There were systems to check and maintain the safety and suitability of equipment and the premises and these checks were up-to-date. Staff were knowledgeable about the procedures relating to safeguarding and whistleblowing. Safe recruitment checks were carried out and there were adequate numbers of staff to meet people’s needs.

Some people thought staff were caring and things had improved since the current manager took up their post. Staff respected people’s privacy and dignity and enabled people to maintain their independence.

Staff received regular opportunities for training. The manager was aware of their responsibilities around legislation regarding people’s mental capacity. Staff were knowledgeable about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. MCA is legislation protecting people who are unable to make decisions for themselves and DoLS apply to people where the state has decided their liberty could be deprived in their own best interests to ensure their safety and welfare.

People had a choice of nutritional food and drink and were able to make choices from the menu or ask for alternatives. Staff were aware of people’s dietary requirements. People had access to healthcare professionals as required to meet their day-to-day health needs.

We saw there were group and individual activities on offer to ensure people had their social and emotional needs met. These included activities outside the home. People’s care plans were person-centred and staff were aware of people’s individual needs and preferences. Staff felt able to raise concerns with the managers. People knew how to make a complaint and these were dealt with appropriately.

At the time of our inspection there was no registered manager at this home. 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 previous registered manager had left employment in April 2013. Since this date there have been three managers in post who did not become registered. A new manager was due to start employment in June 2015.

The provider had systems in place to monitor the quality of care and support in the home and to obtain feedback from people using the service and their representatives. Staff told us they felt supported and had regular supervision and appraisals.