Manor Farm is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Manor Farm is registered to provide support to 25 people, some of whom may be living with dementia. At the time of inspection there were 15 people using the service.

There was a registered manager working at the service. 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. Statutory notifications received by the Care Quality Commission showed us that the manager understood their registration requirements.

At the last inspection in September 2017, the service was rated Inadequate overall and was in breach of multiple regulations. A new management team had been in place for three weeks at the time of that inspection and was already making improvements. The service provided us with an action plan stating how they intended to make the required improvements. At this inspection we found that the necessary improvements had been made to comply with all the regulations previously breached. The service is now rated ‘good’ in all key questions.

The service was meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) 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 and their relatives told us they felt safe living in the service and that staff made them feel safe. Risks to people were appropriately planned for and managed. Medicines were stored, managed and administered safely.

Checks were carried out to ensure that the environment and equipment remained safe. The service was clean and measures were in place to limit the risk of the spread of infection.

People told us there were enough suitably knowledgeable staff to provide people with the care they required promptly. Staff had received appropriate training and support to carry out their role effectively. Staff received appropriate supervision which helped them develop in their role.

People received appropriate support to maintain healthy nutrition and hydration. People told us there had been significant improvements in the quality of the food.

People told us staff were kind to them and respected their right to privacy and that staff supported people them remain independent. Our observations supported this.

People told us they were encouraged to feed back on the service in a number of different ways and participate in meetings to shape the future of the service. People told us they knew how to complain and felt they would be listened to.

People received personalised care that met their individual needs and preferences. People and their relatives were actively involved in the planning of their care. People were supported to access meaningful activities and follow their individual interests.

The registered manager and deputy manager created a culture of openness and transparency within the service. Staff told us that the registered and deputy managers were visible and led by example. Our observations supported this.

There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service. Significant improvements had been made in the service in a short time frame which demonstrated to us that the management team were effective.

Further information is in the detailed findings below

Manor Farm Care Home provides care and support to a maximum of 25 older people, some of whom were living with dementia. At the time of our visit there were 21 people using the service.

The inspection was unannounced and took place on 5 September 2017.

At our previous inspection on 3 and 7 February 2017, we identified widespread failings which put people at risk of harm. The service was found to be in breach of regulations 9, 11, 12, 17 and 18 of the Health and Social Care Act 2010 (Regulated Activities) Regulations 2014. We rated the service inadequate. At this inspection we found that the service continued to breach these regulations and remains inadequate.

The home had a manager in place who was in the process of registering with us. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

Three weeks prior to our inspection the registered manager resigned from their role and a new manager began working at the service. The deputy manager had also stopped working for the service and a new deputy manager had started a week prior to our inspection. Whilst significant progress had been made in the three weeks since the new manager started at the service, there were still significant shortfalls in the care provided to people. This was linked to a lack of oversight from the previous registered manager, deputy manager and the provider. In our report when we refer to the failings of the ‘previous management team’, this includes the provider of the service.

People were put at the risk of significant harm in the absence of clear records and assessments which reflected all current areas of risk and how these should be managed to protect the person from harm. Whilst the new management team was prioritising writing new care plans, the documents in place at the time of our inspection were not fit for purpose.

People were supported by staff to have maximum choice and control of their lives. However, assessments of people’s capacity and Deprivation of Liberty Safeguards applications had not been completed appropriately.

People were not supported to maintain good nutrition, and action had not been taken by the service to reduce the risk of people becoming malnourished.

People were not supported to live full, active lives and to engage in meaningful activity within the service. We observed that some people were socially isolated and disengaged from their surroundings. The new management team had plans in place to address this shortfall, which included the recruitment of two new activities staff.

The care plans and assessments currently in place for people were generic and not person centred. Care planning did not include enough information about people’s past lives and experiences for staff to understand them. People and their representatives were not consistently involved in the planning of their care, and their views were not reflected in their care records. The new management team was rewriting all the care plans at the time of our visit and planned to involve people in this process.

The staffing level in the service had improved and the new manger had in place a system to ensure effective deployment of staff.

The previous management team had not made improvements to the training and knowledge of staff. Staff were not consistently supported to develop their skills within the caring role. There was no system in place to assess staff competency and performance. The new management team had implemented a supervision system and had identified shortfalls in staff training which were being addressed. Plans were in place to carry out staff appraisals.

There was a failure of the previous management team to ensure that systems in place to monitor the quality of the service were effective in

Manor Farm Care Home provides care and support to a maximum of 25 older people, some of whom were living with dementia. At the time of our visit there were 23 people using the service.

The inspection was unannounced and took place over two days, on 3 February 2017 and 7 February 2017.

The home had a registered manager in place. 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 requirements in the Health and Social Care Act 2008 and associated regulations about the service is run.

We identified significant shortfalls in the care provided to people using the service. This was linked to a lack of oversight from the registered manager, deputy manager and provider.

People were put at risk of significant harm in the absence of clear records and assessments which reflected all current areas of risk and how these should be managed to protect the person from harm.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People were not supported to maintain good nutrition, and action had not been taken by the service to reduce the risk of people becoming malnourished.

People were not supported to live full, active lives and to engage in meaningful activity within the service. We observed that some people were socially isolated and disengaged from their surroundings. Some people made negative comments about the sources of activity on offer. This had not been independently identified by the service so no action had been taken by the registered manager to address this.

People’s care plans and assessments were generic and not person centred. Care planning did not include enough information about people’s past lives and experiences for staff to understand them. People and their representatives were not consistently involved in the planning of their care, and their views were not reflected in their care records.

People told us and we observed that there were not enough suitably trained and experienced staff available to meet people’s social, emotional and physical needs. Staffing levels were not calculated by the management based on the needs of people using the service and there was no system in place to monitor the effectiveness of the staffing numbers.

Staff were not consistently supported to develop their skills within the caring role. There was no system in place to assess staff competency and performance. Supervision and appraisal of staff was not carried out consistently and it was unclear how staff skill was developed to ensure the care provided to people was of good quality.

Systems in place to monitor the quality of the service were ineffective in identifying shortfalls and areas for improvement. There was not an open culture within the service. The managers were not visible and did not take a leading role in directing care staff. A health professional told us they did not know who the manager was, and people told us they did not see the managers very often.

Staff recruitment was conducted in such a way that ensured prospective staff had the skills, background, experience and knowledge for the role.

Medicines were managed and administered safely by staff. Improvements were required to ensure protocols for the administration of ‘as and when’ (PRN) medicines were available to staff.

Throughout the two inspection visits we identified such serious concerns that we fed these back to the registered manager so action could be taken to protect people from harm. In addition, we shared information about the concerns we identified with the local council’s safeguarding team and local commissioners. Following the inspection, we wrote to the provider to request information about how they intended to make the urgent i

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This is a residential care home that can accommodate up to 25 older people. Although this is a newly registered service with a new provider, the registered manager and most of the staff have worked in the home for a number of years. 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 and associated Regulations about how the service is run.

People and their relatives were very complimentary about the support provided by this service. They told us they felt safe and supported well. Individual risks had been assessed and staff were working in line with those risk assessments.

Staff were recruited and given an induction to the job required to ensure they knew what was expected of them. Training and individual staff development was encouraged. Many of the staff held a recognised qualification.

Medicines were managed safely and staff followed set procedures to ensure they gave people their medication correctly.

Staff were aware of the Mental Capacity Act (MCA) and Deprevation of Liberty Safeguards (DoLS). However, the manager was also aware that staff required training to enhance their knowledge further.

People were offered choices for their meals and people who required support were given that support appropriately as written in their risk assessments.

People using the service told us how kind, caring and compassionate the staff were. We observed staff supporting people in a caring manner and noted that people were smiling and interacting positively. Some methods used for people’s records could be improved upon.

Throughout the day we saw people were involved in what they wished to do. Choices were available and staff interacted in a manner that empowered people to make choices.

The new provider was proactive with their involvement in the home on a regular basis. Staff were supported and asked for their views on the service. However more formal records such as staff appraisals and support need to be improved upon.

People who used the service and their relatives were asked about the quality of the service

provided. They told us that they were actively involved in making choices regarding the alterations taking place to their home environment.

The manager told us that the provider had been visiting other residential care services to gain ideas on providing better care and further improve the environment for people.