About the service:

Perton Manor is a care home that accommodates 50 people in one adapted building. The home is split into two sides the east and west side. At the time of our inspection 46 people were living at the home. There are various communal areas, including lounges, dining room and conservatory that people can access. The home also has a large garden.

People’s experience of using this service:

The home was exceptionally well led. People and staff were involved with the running of the home and encouraged to progress. There was an emphasis on continual learning and the provider and staff used this to continually develop the home for people. The home had strong links with the community and external agencies who they worked in partnership with. People, relatives and staff felt involved with the running of the home and were actively engaged with the provider on continually improving.

The care people received was safe. Individual risks were considered. Safeguarding procedures were in place. Medicines were manged in a safe way. There were enough staff available for people. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. They 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. Staff received training that helped support people. People received support from health professional when needed. People enjoyed the food and were offered a choice. The environment was adapted to meet people’s needs.

People and relatives were happy with the staff and supported in a kind and caring way. People were offered choices, remained independent and their privacy and dignity was maintained.

People received care that was responsive to their needs. The care they received was individual and specific to their needs. People had the opportunity to participate in activates they enjoyed. There was a complaints procedure in place.

More information is in the full report.

Rating at last inspection:

Good (Last report published 22 December 2017)

Why we inspected:

The inspection was brought forward due to information of concerns we received about the service. However, we found these concerns were not substantiated.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection visit took place on 31 October 2017 and was unannounced. The service was registered to provide accommodation for up to 50 people. At the time of our inspection, 50 people were using the service. Perton Manor is divided into two wings; the east wing accommodates people with complex mental health needs, the west wing accommodates people who are living with dementia and may have physical care needs and/or nursing needs. On our previous inspection on 30 March 2016 we rated the service as Good in all areas. On this inspection the service remains Good overall although Requires Improvement within our question, ‘Is this service effective?’

There was a registered manager 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 made everyday decisions about their care and staff helped them to understand the information they needed to make. However where people were unable to make decisions, how their capacity was assessed was not always clear and some decisions were being made by relatives when the person may have been able to make these decisions themselves. People had meals and drinks served using a dementia range crockery made from plastic. Although other ranges were available, people were not offered a choice of using standard crockery and cutlery.

People felt safe and where risks associated with their health and wellbeing had been identified, there were plans to manage those risks. Where restrictions to people’s liberty had been identified, an application to make this lawful had been made. Staff were trained in safeguarding and understood how to recognise and report any abuse. People received the right medicines at the right time and medicines were handled and managed safely.

Staff had the skills and knowledge to provide care for people and knew people well. People had a choice of what to eat and drink and specialist individual diets were catered for. The staff liaised with health care professionals to ensure that people received the specialist care they needed. People’s support plans reflected the care and support they needed and included advice from external professionals.

People had developed respectful relationships with the staff who were kind and caring in their approach. People’s privacy and dignity were respected and they were supported to be as independent as possible. People were supported to maintain relationships with people that were important to them and visitors were welcomed at the home.

People were able to take part in meaningful activities. The staff had thought of different ways people could express themselves and be involved in activities in the home and when out. People were encouraged to complain or raise concerns, and these were resolved to ensure improvements within the service.

There was strong leadership which promoted an open culture and staff understood their roles and responsibilities which helped the home to run smoothly. People could share their views about the service and this was used to understand what people liked and where improvements were needed.

The registered manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us and kept us informed us important events that happened at the service.

This inspection was unannounced and took place on 30 March 2016. The service was registered to provide accommodation for up to 50 people. At the time of our inspection, 49 people were using the service. Perton Manor is divided into two wings; the east wing accommodates people with complex mental health needs, the west wing accommodates people who are living with dementia and may have physical care needs and/or nursing needs.

There was a registered manager 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.

Our last inspection took place on 4 March 2015, and at that time we asked the provider to make improvements in the way they safeguarded people and protected them from harm. At this inspection, we found improvements had been made. Staff were aware of the different types of abuse that could happen and were confident in how to raise any concerns. We had also asked the provider to make improvements to ensure the way they checked the quality of the service was more effective. We also asked them to demonstrate how they would reduce the risks of incidents occurring. Again, we found that improvements had been made. We saw the provider had analysed information which resulted in reductions in incidents.

We found that risks to individual were managed and staff were skilled in protecting people from harm. Staff were aware of potential risks and supported people in a safe manner. There were enough staff to meet people’s needs and staff were recruited in a safe way. Medicines were managed safely and staff were trained to do this.

When people were not able to make decisions for themselves, we saw that capacity assessments had been completed and decisions about their care and support were made in their best interests. When people who lacked capacity were being restricted, the provider had ensured this authorised legally.

Staff had the knowledge and skills they needed to support people and meet their needs. People were supported to have sufficient to eat and drink and to maintain their health.

People were treated in a kind and caring way, and their dignity and privacy was promoted and respected. People were encouraged to be as independent as they could be and were encouraged to make decisions about their care and support. Relatives were also encouraged to be involved with the planning and review of people’s care.

Staff knew people well and supported people to take part in activities and follow their interests. People knew how to raise any issues or complaints and we saw the provider had dealt with these and people had been listened to.

People spoke positively about the home and felt it was managed well. They were also encouraged to share their experiences with the management team.

We inspected Perton Manor on 4 March 2015 and it was unannounced. At the last inspection on 20 August 2014, we asked the provider to make improvements to ensure that care and treatment was planned and delivered safely. We also asked for improvements to be made to how the quality of care was assessed and monitored. We found that some improvements had been made, but further improvements were still required.

Perton Manor is registered to provide accommodation and nursing care for up to 50 people over two separate units. People who use the service have physical health and/or mental health needs, such as dementia. The ‘west wing’ was primarily for people who had nursing needs and the ‘east wing’ was primarily for people who suffered from dementia who may have behaviours that challenged. At the time of our inspection there were 44 people who used the service.

The service 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 the time of the inspection the registered manager was unavailable.

People who used the service were not always protected from harm. The provider had a system in place to ensure people were safe from harm but this was not effective.

We found that improvements were needed to the way the provider monitored the quality of care. Improvements were also required to ensure incidents were monitored and managed to prevent further harm from occurring.

We found that there were enough suitably qualified staff available to meet people’s assessed needs. The provider had a system in place to ensure that staffing was provided in accordance with people’s dependency needs.

People’s risks were assessed. We saw that staff supported people in a safe way and they were aware of people’s individual risks.

Staff received regular training which ensured they had the knowledge and skills required to meet people’s needs. Staff told us that they felt supported by the manager.

Some people who used the service were unable to make certain decisions about their care. We found that mental capacity assessments had been carried out in accordance with the Mental Capacity Act 2005. We saw that decisions were made in people’s best interests when they are unable to do this for themselves.

People told us that the quality of the food was good and they were given meal choices. We saw that assessments were in place to ensure that risks of malnutrition were reduced.

Staff treated people in a caring and kind way and respected their dignity. Staff supported people to make choices about their care.

People told us that staff knew how they liked there care provided. We found that staff understood people’s preferences in care and people’s social needs were being met.

Staff told us the management team were approachable and that they listened to them. People were encouraged to feedback their experiences and these were acted on to improve the quality of care provided.

The provider had an effective system in place to investigate and respond to complaints.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We visited Perton Manor on a responsive inspection because we had received concerns about the health, safety and welfare of people who used the service. This inspection was unannounced which meant that the service did not know we were coming.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask –

Is the service safe?

Staff were in sufficient numbers during the day of this inspection so that people who required one to one support were supported.

Some staff were not following the providers training in the moving and handling of people who used the service.

We were aware that some concerns regarding the safety of some people who used the service had been referred to the local authority for further investigation.

Is the service responsive?

People’s care needs and level of risk had been assessed, some care plans and risk assessments had not been reviewed recently, some were out of date and did not sufficiently guide staff on people’s current care, treatment and support needs, which put people at risk of inappropriate care.

Is the service caring?

We spoke with visitors to the service. One person told us: “The carers are really nice; my relative’s basic care needs are met. But I worry that my relative does not get stimulation when I’m not here”.

Another visitor told us: “Most of the staff do a very good job in very difficult circumstances; I visit regularly to help care for my relative- I like to do this”.

Is the service effective?

People’s health and care needs were monitored, but the service did not consistently act on issues identified and this meant that people may not have the best possible outcomes and their health could deteriorate.

Is the service well led?

The registered manager of the service was away from the service at the time of this inspection. The clinical lead nurse was in charge of the service and supported us with the inspection.

The management and senior levels of the service had been reorganised and now included a clinical nurse lead, care and deputy care managers.

The service had recently introduced new systems to review the quality and safety of the service. From the findings of this inspection the previous systems for monitoring the quality of the service were ineffective. We have asked the provider to tell us how they will improve in this area.

Perton Manor is a relatively new service having been open since April 2013. We inspected Perton Manor on a responsive inspection as we had received information that people's care and welfare needs were not always being met by a sufficient amount of staff.

Most people who used the service had complex needs and limited communication skills. We observed their care, looked at their care records, spoke with staff and the managers as part of the inspection process.

We found that people's care and welfare needs were being met. A relative of a person who used the service told us: "They treat (X) with respect here".

We saw that generally staffing levels were appropriate to meet the needs of people who used the service.