The inspection took place on the 27, 28 and 31 October 2016 and was unannounced. Manor View provides accommodation and care for up to eight people who live with learning and physical disabilities. At the time of our inspection eight people lived at the home. At our last inspection 30 November 2015 we found that medicine practices were not safe and there was a breach of regulation 12.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. The registered manager is also the provider for this location.

People were not always supported to pursue social interests and take part in meaningful activities relevant to their needs, both at the home and in the wider community.

Relatives and staff were complimentary about the registered manager and how the home was run and operated.

People were unable to communicate with us as too whether they felt safe, happy and well looked after at the home. However relative’s and our observations confirmed that people were safe.

Staff had received training in how to safeguard people from abuse and knew how to report concerns, both internally and externally.

Safe and effective recruitment practices were followed to ensure that all staff were suitably qualified and experienced. Arrangements were in place to ensure there were sufficient numbers of suitable staff available at all times to meet people’s individual needs.

Plans and guidance had been drawn up to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe.

Relatives were positive about the skills, experience and abilities of staff who worked at the home. They received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way.

Staff had developed positive and caring relationships with the people they cared for and clearly knew them very well. People were involved in the planning, delivery and reviews of the care and support provided. The confidentiality of information held about their medical and personal histories was securely maintained throughout the home.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Complaints were recorded and investigated thoroughly and responded to in line with their service policy.

The inspection took place on 30 November 2015 and was unannounced. At our last inspection on 24 September 2014, the service was found to be meeting the required standards in the areas we looked at. Manor View provides accommodation and personal care for up to eight adults who live with learning and physical disabilities. At the time of our inspection eight people lived at the home.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

We checked whether the provider worked within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of the inspection we found that DoLS applications had been submitted in line with MCA requirements for everybody who lived at the home in order to keep them safe from harm.

People were supported to take their medicines by trained staff. However, the systems used to monitor and review the administration of medicines at the home were not as safe or effective as they should have been in some cases.

Some people’s relatives and staff expressed concerns about a shortage of nursing staff and the increased use of temporary staff in light of recruitment difficulties. We found there were sufficient numbers of suitable staff available to meet people’s needs in a calm and patient way.

People who were present at the home during our inspection were unable to communicate with us. Relatives told us that their family members were kept safe. Staff had received training in how to safeguard people from abuse and knew how to report concerns both internally and externally.

Safe recruitment practices were followed but we found that the information obtained about employment histories was not as full as it should have been in order to satisfy the regulations.

There were plans and guidance to help staff deal with unforeseen events and emergencies. The environment and equipment used were regularly checked and well maintained to keep people safe. Potential risks to people’s health and well-being were identified, reviewed and managed effectively.

Relatives and healthcare professionals were positive about the skills, experience and abilities of staff who worked at the home. Staff received training and refresher updates relevant to their roles. However, formal supervision meetings were not always carried out as regularly or consistently as they should have been.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

Staff made considerable efforts to ascertain people’s wishes and obtain their consent before providing personal care and support, which they did in a kind and compassionate way. However, guidance provided to staff did not always accurately reflect people’s involvement in the planning and delivery of care.

We saw that staff had developed positive and caring relationships with the people they cared for. The confidentiality of information held about people’s medical and personal histories had been securely maintained throughout the home.

We saw that care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs and took account of their preferences wherever possible. Staff knew the people they looked after very well and were knowledgeable about their background histories, preferences, routines and personal circumstances.

People were supported to take part in meaningful activities relevant to their needs, both at the home and in the wider community. Relatives told us that staff listened to them and responded to any concerns they had in a positive way. Complaints were recorded and investigated thoroughly with learning outcomes used to make improvements where necessary.

Relatives, staff and professional stakeholders very were complimentary about the registered manager and how the home was run and operated. Steps were taken to monitor the quality of services provided, reduce potential risks and drive improvement. However, these were not always as effective as they could have been.

At this inspection we found the service to be in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our last inspection on 9 May 2014 we found that some areas of the home were not clean and hygienic. We asked the provider to submit an action plan to the Care Quality Commission to tell us how they would address these issues. We followed up with an inspection on 24 September 2014 to ensure that action had been taken.

The inspection team was made up of one inspector. As part of this inspection we spoke with the manager and three members of staff. We checked the environment to confirm that improvements had been made and also reviewed records that related to infection control. We found that shortfalls identified during our last inspection had been addressed or that work to resolve these was in progress and close to completion. The provider may wish to note that not all staff were up to date with their food hygiene training. This meant that some staff may not be aware of their role with regard to food safety and infection control.

The Inspector gathered evidence to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring, Is the service responsive? Is the service well led?

Below is a summary of what we found based on the evidence gathered during our inspection carried out on 09 May 2014. This included observations of care and support being delivered, speaking with members of staff and by looking at records.

The detailed evidence that supports our findings can be read in the full report.

Is the service safe?

Care and support was delivered in a way that promoted people’s dignity and independence.

We looked at care records which showed that people’s needs and preferences had been assessed, documented and reviewed. They were personalised and gave staff clear guidance about the care and support people needed.

We found that appropriate standards of cleanliness and hygiene had not been maintained in all areas of the home. For example, we saw that floor coverings in some areas had been poorly maintained and therefore could not be cleaned properly. This meant that people had not been adequately protected against the risks of health care associated infection.

Is the service effective?

We looked at care records which showed that people’s choices and preferences had been taken into account in the planning and delivery of the care they received. These provided staff with clear guidance about how to support people to express choices and make decisions about what they wanted to do and how they spent their time.

We saw that risk assessments had been completed and regularly reviewed in relation to a range of issues relevant to people’s care needs and personal circumstances. These included moving and handling requirements, skin and pressure area care and the management of people’s medicines.

The provider had suitable arrangements in place to ensure that staff were trained and supported to perform their roles and deliver care safely. For example, we saw that an induction programme, based on nationally recognised standards, had been used to help train, support and develop new members of staff.

Is the service caring?

We saw that staff treated people with respect and kindness while delivering appropriate levels of care that met their individual needs and welfare requirements.

Staff treated people in a patient and caring way. They demonstrated a good understanding of people’s health, welfare and communication requirements. This meant that care and support was delivered in a way that best suited and met people’s individual needs.

Is the service responsive?

We saw that staff used a wide range of communication methods, both verbal and non-verbal, to explain what was happening and ascertain people’s choices in a way that promoted their independence.

The provider had a complaints and compliments policy and procedure in place. We saw that people who lived at the home had been provided with guidance about how to make a complaint. The information provided was in an ‘easy read’ format with words, symbols and pictures appropriate to their communication needs.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. They were knowledgeable about the care and support needs of people who lived at the home.

We saw that people had been supported to access relevant health care professionals where necessary and appropriate. These included GP’s, dentists and speech and language therapists. This meant that care and support had been planned and delivered in a way that took account of people’s individual needs and personal circumstances.

The provider had systems in place to assess and monitor the quality of services provided and to identify, assess and manage risks posed to the health, welfare and safety of people who lived at the home.

Not all of the people living at 45 Manor View were able to communicate with us verbally. We observed care being provided and we spoke with people's relatives who told us that people were encouraged to carry out tasks for themselves. One person said "On the whole it is very good; my relative is very happy there".

Another told us that the standard of care was very good and that they were involved in decisions about the care of their relative. They said "I get consulted about care and I get letters to keep me informed about medical treatment and tests". Relatives also told us that they felt people were safe and looked after well at this location.

There were some concerns expressed about staff numbers with one relative saying "My biggest worry is that they are quite short staffed; they used to have a cook but not anymore. The residents don’t get out as much as they should as they need two carers to take them out."

A care manager from the local authority told us that the people living there were supported to access their families and the community and that the person they represented was always happy and smiling.

During our inspection of Manor View we found ample evidence that every effort was made to identify and act on the wishes of people who lived there. A relative told us, “They go to extraordinary lengths to obtain [name] consent about everything and always speak with me if in any doubt.”

However, suitable arrangements in line with published guidance relating to the Mental Capacity Act (MCA) 2005, were not in place where necessary to properly assess people’s ability to make decisions.

Care plans we looked at showed that people’s needs and preferences were thoroughly assessed, documented and reviewed. When asked if they were happy living at the home, one person smiled and said, “Yes I am.” A relative told us, “I simply cannot fault the care; it is absolutely wonderful in every respect.”

The premises were safe, suitable and fit for purpose. Adequate emergency procedures were in place and the safety equipment we saw had been regularly checked and well maintained.

Records showed the provider had effective recruitment procedures in place to ensure that staff were fit, able and properly trained to meet the needs of people who used the service. The procedures included carrying out appropriate checks before staff began work.

The provider had an effective policy and procedures in place for recording and dealing with complaints. An ‘easy read’ guide using pictures had been produced to help people understand how to make a complaint and the methods used to resolve it.