Manor Farm Residential Home is registered to provide accommodation for up to 20 people requiring assistance with personal care. During our inspection there were 15 people living in the home.

Accommodation is offered over two floors and consists of single or double bedrooms, a number with en-suites and all offering washing facilities. There are two lounges available to people and the dining room is situated within a large conservatory overlooking the garden.

We last inspected Manor Farm Residential Home 20 January 2016 and 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.

There was a comprehensive programme of quality audits managed by the registered manager. These included health and safety, infection prevention and control and a kitchen audit. The service had received a 5-star rating from the Food Standards Agency.

The registered manager used a staffing dependency tool to ensure that there was enough suitably qualified staff to meet the needs of people living in the home. The dependency tool considered people’s individual needs and was reviewed when these changed or monthly.

People, staff and relatives spoke positively about the registered manager and provider. Staff said that the registered manager was approachable and that they felt comfortable to speak with the provider if the registered manager was absent. One staff member said, “I go to [registered manager’s name] first, haven’t had to go further than [Registered manager’s name].”

A copy of the providers complaints policy was displayed in the main hallway. There had been no formal complaints about the service in the previous year, the last formal complaint being recorded in 2015.

People were offered a variety of food and drink, with themed meals and experiences being built around specific types of food. For example, during the warmer months ‘fizzy Friday’ offers people the opportunity to taste different types of fizzy drinks and this is changed to ‘frothy Friday’ during the cooler months when people are offered hot drinks, including hot chocolate with marshmallows. People who do not wish to participate are offered alternatives.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

During our previous inspection, we made a recommendation to the provider regarding environmental health and safety risks. During this inspection we revisited these recommendations and saw evidence that the shortfalls had been addressed. More information can be found in the main body of the report.

Further information is in the detailed findings below.

We inspected the service on 20 January  2016. This was an unannounced inspection. Inspection. The service was last inspected in May 2013 when it was compliant with the regulations at that time.

The service is registered to provide accommodation and personal care for up to 20 people. At the time of our inspection there were 16 people living at the home.

There was a registered manager for 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.

Staff had been on training to help them to understand what abuse was and how to report concerns if they thought someone was at risk of abuse.

Some environmental health and safety risks required assessing and possible action to be taken. This was to ensure that risks were minimised to keep people safe.

People were assisted by enough staff to provide them with safe care. Staffing numbers were increased when it was needed. For example if people’s needs changed because they were physically unwell.

People spoke highly of the food they were served. One person said, “It’s like good old fashioned home cooking”. People were provided with a varied diet that supported them to be healthy. The chef worked closely with people and ensured that menus included their likes and preferences when planning meal choices.

There was a system in place to ensure that the requirements of the Mental Capacity Act 2005 were implemented. This legislation protects the rights of people who lack the capacity to make informed decisions in relation to different aspects of their lives.

We found that while people spoke very highly of the staff team they thought that one member of staff was often abrupt and harsh in their manner and approach to people.

We found that staff were caring in their approach to people when they assisted them with their needs. One person said, “They are marvellous and they can’t do enough for you, they are my friends. Staff were polite and showed respect to the people they supported with their care

People were able to take part in a variety of individual social activities as well as group ones. People told us that entertainers performed at the home regularly and they went out for trips into the local area. On the day of our visit, a singer performed and people were singing and playing musical instruments along with them.

The registered manager ensured that people were involved in the planning and writing of their care plans if they wanted to be. This was to help ensure that people were supported in the way they preferred. The care plans set out very clearly how to meet people’s care and support needs.

People were supported with their physical health care needs. The staff liaised with external healthcare professionals to get specialist advice and medical input for people when it was needed.

Staff felt they were very well supported in their work by the registered manager and by each other. People who lived at the home and the staff spoke very highly of the registered manager. Comments made about the registered manager included “They are very kind”, “They are a very caring person” and “You can go to them about anything”.

Staff had an understanding of what the provider’s visions and values were for the service. They were able to explain that a key value was to always treat people as if they were at their own home.

The registered manager had a system in place to ensure that people were regularly asked for their views of the service. Where actions were needed to improve standards these were acted upon immediately. There was also a system in place to monitor and improve the quality of the service. Audits demonstrated that regular checks were undertaken on the quality of the service.

We have made a recommendation to the provider around environmental health and safety risks.

This was a responsive inspection because of safeguarding concerns we had received. There had been concerns around the care of people who had complex health needs. We had also received information of concern about staff in the home. The home had recruited a new manager. In consultation with the local authority we agreed to visit once they had been in post for three months. We could then look at progress the manager had made in addressing the areas of concern.

Care plans were comprehensive and provided guidance to staff about the complex needs of people. The provider had identified potential health and welfare risks through their assessment arrangements. They had consulted with other professionals to ensure appropriate care and support could be provided.

Staff told us there had been improvements made in the running of the home. They said there was now more structure and they were more aware of people's care needs. They also told us that they were now able to spend quality time with people. People we spoke with were very positive about staff. One person commented that they felt care was better since the new manager had started and that there were more activities available. Another person told us "it seems a happier place".

There were suitable arrangements in place for the management of medicines. Staff had received training so that they had the knowledge and skill to manage medicines in the home.

In January 2012 we carried out an inspection of the service. At this time we made several compliance actions and issued a warning notice. The warning notice told the provider that staff were not being appropriately supervised and had not received adequate training.

We carried out this unannounced inspection to ensure the provider was compliant with those actions.

The people who use the service that we met and talked with were very positive about the staff and the way they were supported by them. One person told us "The staff are really nice girls".

We spoke to staff who told us that they felt "things at the home had improved" and that they felt that "they had turned the corner". Staff told us that they had received a range of training and that they had received one to one supervision.

The provider had ensured that the quality at the home was monitored and assessed. An external consultant and an interim manager had developed a system to ensure that audits and checks were completed. There were plans in place to ensure that these continued.

In August 2011 we carried out an inspection of the service and made several compliance actions. We carried out this unannounced inspection to ensure the provider was compliant with those actions.

The people who use the service that we met and talked with were very positive about the staff and the way they were supported by them. We asked one person if they thought that there were enough staff on duty including at weekends. They told us that they thought there were sufficient staff. One person told us "The staff are really nice girls".

People said that they appreciate having their own rooms, and being able to choose how

they are decorated. One person told us "I choose the things I like to have in my room".

People told us that they liked living at the home. One person said "I'm really happy here it's my home".

When discussing personal choice, one person told us "I can get up when I like. If I don't

feel very well I go back to bed ". Another person told us "It's lovely. There is nothing

wrong with the place. I've got lots of freedom".

Four people who use the service told us that they felt safe at the home and that staff are "kind and considerate".

People told us that the food was "lovely" and that there was plenty to eat at times that

suited them. One person said "I can't fault the food".

Staff members we spoke with told us that knew about the whistle blowing policy. One

person said "There is a lot of whistle blowing going on at the moment. It's caused a lot of tensions in the staff team ".

From December 2011 to February 2012 we attended three safeguarding meetings

regarding concerns raised about the care of people living in the home. The subsequent

investigations and actions taken to discipline staff showed us that people had not always received safe care. As a result of the safeguarding concerns, in December 2011, the local authority stopped the placements of people into the home.

The issues, raised at the safeguarding meetings, included concerns about the manual

handling assessments and risk assessments for the use of specialist equipment such as a slide sheets or rotunda. Risk assessments did not provide enough information to support staff members in assisting people with safe movement and transfers. We read in one persons care file that they were concerned about the way staff had transferred them onto their bed. During our visit we saw a staff member transfer a service user in a wheelchair. We saw that they did not put the wheelchair foot plates down for this person. This person was put at risk of injuring their feet during the wheel chair manoeuvre.

There were also issue about unsafe staff practices in relation to the administration of

medication. We looked in the manager's personal file and did not see any evidence that

the manager had undertaken additional training in the administration of medication to

ensure they understood safe practice.

Members of the safeguarding meeting were concerned that the manager and the provider did not always inform the appropriate agencies about safeguarding incidents.

Following our visit a health professional told us they had visited the home and had been

concerned about aspects of medication safety, as they had seen that the keys to the

mobile medicine cabinet were in the lock of the cabinet. They were concerned that the

cabinet was unattended by staff members.

At our visit we saw that staff members were not properly trained or supervised. Some staff members have not received an induction when starting work at the home. The manger had not received any supervision, appraisal or induction. Staff members did not receive additional training after poor practice has been identified.

We have issued a Warning Notice about Regulation 23 (1) (Outcome 14) which requires

the registered provider to take action by 16 April 2012 to meet the regulatory requirements. If this is not achieved further enforcement action may be taken.

We spoke with people who used the service and we met one friend of a resident who was available at the time of our visits to gain their views.

Service users told us that they felt safe at the home and that staff were “lovely girls”. Two people told us staff were sometimes rushed and looked tired.

People told us that the food was usually ‘lovely’ and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

We noticed unpleasant odours in the lounge and in one of the bedrooms.

Although people had positive comments to make about the home we were concerned about some of the things we noticed when we visited. We were told both by people living and working at the home that there had been a problem with staffing for a while. At the time of the site visit the home was without a manager and we were told that often there was not enough staff. We found this was having a negative impact for people living at the home were in a number of ways. There had been incidents of aggression between some service users, who needed a lot of staff time to support their needs. People moving to the home often do not have their needs properly assessed and we found care plan records did not adequately address the needs of people living at the home. Staff did not always have the appropriate knowledge and skills to support the needs of people in their care. For example, failure to provide correct information for a person moving to a new home had been resulted in their medical treatment being compromised. Staff had not followed correct infection control procedures to minimise cross infection risks in the home. We found that the visiting district nurses were having visit frequently to educate and support the care staff in meeting the needs of people.

We spoke with people who used the service to gain their views.

Service users told us that they felt safe at the home and that staff were “very kind”. One person said “I was lonely at my home and I am lonely here”.

People told us that the food was “lovely, especially the puddings” and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

We noticed unpleasant odours in the lounge and in the main entrance.

Since our last site visit there have been some improvements. The manager has worked hard to meet the compliance and improvement actions from our previous report dated December 2010. She has started a new programme of staff training. People moving to the home now have their needs properly assessed and we found that care plan records have started to adequately address the needs of people living at the home.

Although people had positive comments to make about the home we were concerned about some of the things we noticed when we visited. We were told, both by people living and working at the home, that there had been a problem with staffing levels. At the time of our visit the manager told us that she had assessed the need for three staff to be on duty so that people can be cared for safely. We saw that these staffing levels were not consistently maintained. The manager told us she will ensure these staffing levels will be in place in the future.

People whose health needs change whilst they are living at the home do not always received sufficient care from the staff team.

Staff do not always know the staffing structure in the home and are unclear about who is in charge when the manager is not on duty. We found that peoples’ care has been compromised at times when the manager was absent from the home. The provider has taken charge of the home in these circumstances, but she has demonstrated that she does not always have the appropriate skills to do so safely. This means that people cannot be assured that their needs will be met at all times.

The provider failed to provide correct information for a person moving to hospital and failed to ensure their medication was available at the home in a timely manner. This resulted in their medical treatment being compromised.

Staff had not followed correct infection control procedures to minimise cross infection risks in the home.