About the service:

Manor House is situated in Hexthorpe, a suburb of Doncaster. The service provides accommodation and personal care for up to ten people who have learning disabilities. At the time of the inspection eight people were using the service. This included one person who was living in a flat that is an annex to the main building.

People’s experience of using this service:

The service was developed and designed before the guidance, Registering the Right Support came into being. However, the registered provider worked to make sure the service was run in line with the values that underpin this and other best practice guidance. These values include choice, promotion of independence and inclusion. The service adhered to the principle that people with learning disabilities and autism should be able to live as ordinary a life as any citizen.

People received support which was tailored to their needs, delivered by staff who treated them with respect and understood their goals and aspirations. Staff treated people with warmth and empathy, and exhibited a passion for their roles.

The management team had fostered a culture of openness and improvement. There was effective communication between staff and managers, underpinned by team meetings, staff supervision and appraisal. Staff received training and support to make sure they had the skills and knowledge to carry out their role effectively.

People had access to healthcare services as required. 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 protected against the risk of abuse. Staff had received training in relation to safeguarding, and records showed the provider had taken appropriate steps when people were suspected to be at risk of abuse.

People received support in an environment that was safe. The premises were regularly audited to make sure they were safe and fit for purpose, although there was room to improve the décor in the shared areas. Staff had received appropriate training in relation to health and safety. People’s feedback was regularly sought, so that they could contribute to improvements within the service.

Rating at last inspection:

The service was last inspected on 1 February 2018, where it was rated requires improvement. At inspection we found the registered provider had taken action to address the shortfalls we found at that time, and the rating had improved to good.

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection.

Manor House 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 care home accommodates 10 people. The home provides care and support to people with autism, learning disabilities and mental health conditions. Nursing care is not provided.

The unannounced inspection took place on 1 February 2018.

At our comprehensive inspection in September 2015 we rated the service as 'Good'. At this inspection we rated the service as 'Requires Improvement'.

The registered manager remained in post. 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 felt safe living at Manor House. Staff were knowledgeable in relation to keeping people safe from harm and reporting incidents to management. Staff had appropriate awareness of people's current needs. People were supported by sufficient numbers of staff. People's medicines were managed safely and medicines were administered to people as the prescriber intended. People did not always receive care in a clean, safe and well-maintained environment.

People told us they enjoyed the food provided. Staff sought people's consent prior to supporting them, however records did not always accurately record people's consent to care and treatment. We saw care plans, in which the consent to aspects of care had been signed by relatives or others who did not have power of attorney. There were no best interest decisions documented in relation to others signing these consent forms where people lacked the capacity to consent to their care. Staff told us they felt supported by the management team, and were receiving training and supervision in key areas. People were supported by a range of health professionals when their needs changed.

Staff were observed to have developed positive and caring relationships with people who lived at the home. When personal care was provided, this was carried out in a respectful way that promoted people's dignity.

People were able to pursue their individual interests and meaningful activities. People and their relatives knew how to raise concerns and were kept informed regarding changes within the running of the service.

The provider had some systems to monitor and improve the quality of care people received but did not have a dedicated tool for assessing infection control and cleanliness. Staff received up to date information regarding the service and people but not in a formal setting.

This inspection took place on 24 September 2015 and was unannounced.

When we visited the home in January 2015 we found it was in breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and Regulation 17 HSCA (RA) Regulations 2014 Good governance.

We found that the provider had designed a programme of improvement and changes had been implemented which had a positive impact on those people who used the service.

Manor House provides accommodation and personal care for up to ten people with learning disabilities and autistic spectrum disorders. On the day of the inspection five people were living at the home. The home had a registered manager. 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 that people who used this service were safe. The care staff knew how to identify if a person may be at risk of harm and the action to take if they had concerns about a person’s safety.

The care staff knew the people they were supporting and the choices they had made about their care and their lives. People who used the service, and those who were important to them, were included in planning and agreeing to the care provided.

The decisions people made were respected. People were supported to maintain their independence and control over their lives. People received care from a team of staff who they knew and who knew them.

People were treated with kindness and respect. One person who used the service told us, “It really is very nice here.”

The registered manager used safe recruitment systems to ensure that new staff were only employed if they were suitable to work in people’s homes. The staff employed by the service were aware of their responsibility to protect people from harm or abuse. They told us they would be confident reporting any concerns to a senior person in the service or to the local authority or CQC.

There were sufficient staff, with appropriate experience, training and skills to meet people’s needs. The service was well managed and took appropriate action if expected standards were not met. This ensured people received a safe service that promoted their rights and independence.

Staff were well supported through a system of induction, training, supervision, appraisal and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

The service was well-led. There was a comprehensive, formal quality assurance process in place. This meant that aspects of the service were formally monitored to ensure good care was provided and planned improvements and changes were implemented in a timely manner.

There were good systems in place for care staff or others to raise any concerns with the registered manager.

During our inspection we spoke with two people who used the service. They spoke positively about the care and support they received. One person told us "I am looked after well. I can do lots of activities. I am happy."

We found staff demonstrated a firm commitment to making sure people who used the service were treated as individuals and encouraged to express their views about care and support needs.

People experienced care, treatment and support that met their needs and protected their rights. We found people were supported in taking risks as part of an independent lifestyle. Risk assessments were in place to minimise any identified risks or hazards.

People who used 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. People we spoke with told us they felt safe and staff were kind and caring towards them. One person told us "I can talk to staff about any problems I have."

Evidence showed staff were properly supported to provide care and treatment to people who used the service. We found staff were knowledgeable about the health and welfare needs of people they cared for.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

This inspection took place on 7 and 8 January 2015 and was unannounced. Manor House was last inspected in May 2013 and we found they were meeting the regulations we looked at.

Manor House provides accommodation and personal care for up to ten people with learning disabilities and autistic spectrum disorders. On the day of the inspection five people were living at the home. The home had a registered manager. 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.

We looked at the arrangements in place for the administration and management of medicines and found that these were not always appropriate. We saw medication administration records (MAR’s) which had been handwritten and not signed by staff, medication taken off site without appropriate documentation and creams and liquids without ‘opened on’ dates. Medicines were stored securely in a locked cabinet. Medicines stored tallied with the number recorded on the MAR. Arrangements were in place for the storage of controlled drugs if required and we saw from training records, all staff had received medicines training.

The registered manager was respected by staff, people who used the service and their relatives.

There was a system of audits and formal quality assurance process in place, however some of these were not always carried out with sufficient robustness as to identify issues, for example medication audits. This could mean that the service, whilst formally monitored, may not ensure good care was provided and planned improvements and changes implemented in a timely manner.

Staff working at Manor House understood the needs of people who used the service and we saw that care was provided with kindness and compassion. People told us they were happy with the care provided.

People were relaxed and happy on the day of the inspection. We saw staff talking with people in a friendly manner. We saw staff assisted people as they needed whilst encouraging people to be as independent as possible.

We saw support plans contained information to guide staff who were assisting people. Risk assessments were completed although not all aspects of the support plans were up to date or reviewed in the timescale documented in the service user guide. We found people were supported to live full and active lives and had access to the local community.

People were able and encouraged to take part in activities which reflected their individual hobbies and interests. People were also supported to maintain strong relationships with their families.

Staff were well supported through a system of induction and training. There was a positive culture within the service which was demonstrated by the attitudes of staff and their approach to supporting people to develop their independence. We saw the service was organised to suit the needs of the people who lived there.

People were supported by sufficient numbers of staff on duty. Staff told us that staff could be increased to address changes in risk or changing support needs.

You can see what action we told the provider to take at the back of the full version of the report.