This inspection took place on 24 August 2017 and was unannounced.

The Manor Residential Home (Arnold) Limited provides accommodation for up to 27 older people who require support with their personal care. At the time of our inspection there were 25 people living at the service.

At the last inspection, on 9 and 10 February 2015, the service was rated Good. At this inspection we found that the service remained Good.

The service had a manager who had submitted an application to register with the Care Quality Commission (CQC). They had been in post for two weeks at the time of our 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 using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them.

People had risk assessments in place to enable them to be as independent as they could be in a safe manner.

There were sufficient staff, with the correct skill mix to support people with their care needs. Effective recruitment processes were in place and followed by the service.

Staff received a comprehensive induction process and on-going training. Staff said they were supported by the manager and had supervision meetings. Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people. They were supported to make decisions about aspects of their life; this was underpinned by the Mental Capacity Act 2005.

People usually received enough to eat and drink. Staff did not always give people support to eat when they needed this. Charts to monitor people's food intake were not always completed correctly. People were supported to access health appointments including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People’s privacy and dignity was maintained by staff. Staff treated people with kindness and compassion.

People were involved in their assessments and in developing their support plans. The support plans were reviewed and updated to reflect people’s current needs.

People were encouraged to participate in activities. An activities plan was being developed based on what people wanted to do. Information was available for people on how to raise any concerns or complaints about the service they received. The provider responded to complaints following their policies and procedures.

The manager and provider had identified areas for improvement and were working to develop an action plan to address these.

A variety of quality audits were carried out, which were used to drive continuous improvement and used to good effect in supporting people and staff to express their views about the delivery of care.

Manor Residential Home (Arnold) Limited is a care home providing accommodation and personal care for up to 25 adults. There were 25 people living there when we visited. The care home provides a service for people with physical nursing needs and for people living with dementia. A registered manager was in post.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. However, we found that the service had not taken appropriate action in relation to a potential safeguarding issue. This was a breach of Regulation 11 of the Health and Social Care Act (2008) (Regulated Activities) Regulations 2010 and you can see what action we told the provider to take at the back of the full version of the report.

People were better protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements for staff to respond appropriately to people who communicated through their behaviour. Where people lacked capacity to make decisions, the Mental Capacity Act 2005 was being adhered to.

We found that there were systems in place to ensure people received their medicines as prescribed. Staff were recruited through safe recruitment practices.

There were processes in place to gain the views of people in relation to their care and support. People’s preferences and needs were recorded in their care plans and staff were following the plans in practice. Records and observations showed that the risks around nutrition and hydration were monitored and managed by staff to ensure everyone received adequate food and drink.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they supported them. People were supported to attend meetings where they could express their views about the home.

Staff were able to describe examples of where they had responded to what was important to individuals living in the home. People knew who to speak to if they wanted to raise a concern and there were processes in place for responding to concerns. The registered manager told us there had not been any formal written complaints made by people living in the home or their significant others.

There were effective systems in place to monitor and improve the quality of the service provided. Action plans, in response to audits and incidents, and the follow up of these ensured continuous improvement. The provider had asked for people’s views on the service and staff were supported to challenge when they felt there could be improvements and there was an open and transparent culture in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The deprivation of liberty safeguards are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice.

We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. The registered manager told us there was no one living in the home currently who needed to be on an authorisation. We saw no evidence to suggest that anyone living in the home was being deprived of their liberty. We found the location to be meeting the requirements of the DoLS.

During this inspection we spoke with four people using the service, one relative the provider and the manager and three members of staff.

Everyone we spoke with told us they were happy and settled living at the home. One person said, “Everything is good, the staff are kind to me.” Another person said, “The staff are wonderful, they help me when needed and my needs are met.”

Three people told us they were aware they had plans of care in place and although they had not really been involved in these they knew their relatives had been. They all felt that staff were aware of their preferences and they supported them in the way they preferred.

Although there had been developments in the care planning process, further action was still required in regard to this and the secure storage of records.

Everyone we spoke with told us they felt safe and that staff were well trained to carry out their job role. One person said, “The staff are very good, I feel they are well trained to do their job.” Another person said, “The staff are wonderful, and they are well trained and good at their job.”

One relative told us they felt the staff were well trained and they were good at their job.

We spoke with two people using the service about their involvement in care planning. Both people we spoke with told us they had been involved in the reviews of their care plan.

We spoke with five people about whether they were given choices in relation to how they were cared for and supported. They all told us they were given choices with one saying, “There is always a choice of what to eat and if you don’t like what is on the menu they will get you something else” and another saying, “I spend my day how I choose, there is no problem with that.”

We observed a meal being served in a dining area and we saw most people were able to eat independently. We saw where one person needed support and encouragement, staff offered this in a discreet and respectful manner. We saw the dining experience was a positive one with people chatting and being given time to eat their meal and socialise. There were staff available to assist people if they needed help throughout the meal.

One person using the service told us, “staff are lovely to me. I feel safe here but if I was worried about anything I would talk to the manager or the owner.” All five people we spoke with told us they felt safe in the home and they felt they could speak with staff or the manager if they needed to.

We found ‘resident meetings’ to give people the opportunity to express their views and opinions were regularly held.

We spoke with five people using the service and they told us they felt they would be listened to if they wanted changes to the way they received care. One person said, “I go to the meetings they have here and I have my say.”

We inspected the service on 09 and 10 February 2015. This inspection was unannounced. Manor Residential Home (Arnold) Limited is registered to provide accommodation for a maximum of 25 people. On the day of our inspection 23 people were using the service.

The service had a registered manager in place at the time of our 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 and associated Regulations about how the service is run.

When we last inspected the service on 06 May 2014 we found people who used the service were not always protected from the risk of abuse because the provider had not taken all reasonable steps to identify the possibility of abuse and prevent abuse from happening. The provider sent us an action plan telling us they would make these improvements by 25 July 2014. We found at this inspection that this had been completed and the provider had made improvements in line with the action plan.

We found systems were in place to protect people from the risk of abuse and staff were aware of their roles and responsibilities in this area.

People received their medicines as prescribed and the management of medicines was safe.

Staffing levels were sufficient to support people’s individual needs and people received care and support when they needed it.

People were encouraged to make independent decisions and staff were aware of legislation to protect people who lacked capacity when decisions were made in their best interests. We also found staff were aware of the principles within the Mental Capacity Act 2005 (MCA) and had not deprived people of their liberty without applying for the required authorisation.

People were protected from the risks of inadequate nutrition and dehydration. Specialist diets were provided when required and referrals were made to health care professionals when guidance was needed.

Whilst people were encouraged to contribute to the development of their care plans and were able to be involved in the planning of their care we found people had little interest in the formal care planning process.

People were treated with dignity and respect. Staff were proactive in promoting people’s choice and incorporated a kind and caring attitude when supporting people.

People were encouraged to be involved in decisions about the service and systems were in place to monitor the quality of service provision. People felt they could report any concerns to the management team and felt they would be taken seriously.