Radcliffe Manor House is a ‘care home’ for 26 older people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provider, and both were looked at during this inspection. The building has two floors with a shaft lift and stair lift to access the top floor. There are extensive gardens to the front and rear of the property with accessible pathways.

At our last inspection we rated the service as overall ‘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. There were 26 people using the service at the time of our visit. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were kept safe at the service. Staff recognised signs of any abuse and knew the process to follow to report such incidents. Staffing levels were maintained to ensure people were fully supported in a safe manner. Medicines were stored and handled in line with current regulations.

People’s consent was obtained before any support or care was provided. Staff completed regular training and refresher courses to ensure their knowledge was up to date and people’s needs were met in the correct way. People had access to health care professionals and had a choice of food throughout the day.

Staff were caring and understood the needs of the people receiving support and how their choses were to be provided. People’s independence was respected and supported, with people enjoying trips outside the service when they wanted.

There was a range of activities offered and regular discussions about how people wanted to spend their days. The local community was regularly accessed and a range of meals were available each day with snacks offered between mealtimes. Contact with family and friends was supported and encouraged.

People were happy with the leadership of the service and told us that they knew the registered manager who was actively involved in the daily routines. Staff felt they were fully supported by the management team and were included in any developments of the service.

We carried out an unannounced inspection of the service on 18 May 2016. Radcliffe Manor House is registered to accommodate up to 25 people who require nursing or personal care. At the time of the inspection there 25 people using the service.

On the day of our inspection there was a registered manager in place. 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 could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed. A risk of an unlocked door to the home was identified, but the registered manager had the processes in place to manage that risk whilst not restricting people’s freedom. There were enough staff to keep people safe and people’s medicines were managed safely.

People were supported by staff who completed an induction prior to commencing their role and had the skills, training in place and their performance regularly reviewed to enable them to support people effectively.

The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care. People spoke highly of the food provided and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by staff. A visiting healthcare professional spoke highly of the way staff supported people. Referrals to relevant health services were made where needed.

Staff were kind, caring and compassionate. Staff understood people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained and staff spoke with them in a respectful way. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

The majority of people spoke positively about the activities provided at the home. People’s care records were person centred and focused on providing them with care and support in the way in which they wanted. People were provided with the information they needed if they wished to make a complaint.

The registered manager led the service well and was respected and well liked. People were encouraged to maintain links with their local community. Staff understood what was expected of them in their role. People were encouraged to provide feedback about the quality of the service and this information was used to make improvements. Quality assurance processes were in place to ensure people and others were safe in the home.

We visited the location to check that the provider was compliant with the regulation about which we had set a compliance action at our previous inspection on 14 August 2013.

We spoke with three people using the service. They told us they were happy with the arrangements for their medication and they always got it on time.

We observed a staff member administering medication to people in the dining room at lunchtime. We saw they wore a tabard to identify their role and they were not disturbed by other staff members. We saw they waited with people whilst they took their medication. This meant people who used the service were supported by staff when they took their medicines.

We found that medicines were safely administered and appropriate arrangements were in place in relation to the recording of medicine.

We spoke with two people using the service. They told us their needs were met and staff were caring. One person said, “Oh they’re very caring” and “Nothing [is] too much trouble for them.”

We spoke with three relatives. They told us their family members received good care that met their needs. One relative said, “I think it’s very good actually.”

During our visit we saw positive interactions between staff and people using the service. We spent 40 minutes observing the care at lunchtime in the dining room. We saw staff provided support to people who needed this. We also saw staff communicated warmly with people as they were supporting them.

People using the service who we spoke with told us they were happy with arrangements for their medication. However, we found some gaps in the medication records. We also found that medication was not always stored at an appropriate temperature.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs.

We also found staff received inductions, supervision, training and appraisals.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

When we inspected Radcliffe Manor House on 16 May 2012 we found some risk assessments had not been updated when needs had changed. We saw examples of monthly reviews where information had not been recorded each month. We found that some training had not been completed and we did not see evidence of inductions in some staff files. We visited the service on 8 February 2013 to check whether improvements had been made.

We spoke with three people using the service. One person said the care was, “Smashing”. Another person said, “They look after you very well.” The third person told us they received the care they needed and said it was “reasonable”.

We found that the provider had begun to make some improvements. The deputy manager told us they were producing new care records using new care documentation. However, we saw mixed evidence in one care record as to how the person’s needs had been assessed and reviewed.

We found that the provider had taken some action to address training gaps, but we still found some gaps. We found no evidence of an induction in one staff file and saw that induction documentation had not been fully completed in two other files. We saw no evidence of recent staff supervision or appraisals in three staff files we looked at.

We did not inspect how medicines were managed during our previous visit. However, recent information we received led us to report on this outcome. We found gaps on the medication administration records (MAR) charts.

We spoke with three people using the service. They told us staff respected their dignity and privacy and communicated well. One person said, “They are very nice. They listen to what you say.” Another person said, “The carers are really wonderful”, but told us they would prefer it if more time was available for staff to sit down and have more conversations with them.

They told us they were well cared for and staff provided support that met their needs. They told us they felt safe and would speak with staff if they had concerns.

We also spoke with three relatives who told us their relatives were well cared for.

However, other evidence did not support this. We saw one example where a risk assessment had not been updated when needs had changed. We saw monthly review documents, which showed us that reassessments of needs were taking place. However, we saw examples where information had not been recorded each month or was not detailed. This meant there was a risk that some monthly reviews were not taking place or not being completed thoroughly and staff would not have information about changes in need.

People using the service told us they were happy with their bedrooms and had everything they needed. Two people told us the care home was well maintained and decorated nicely. However, other evidence did not support this. We saw that the building was clean and homely, but was in need of redecoration in some areas.

People using the service told us staff were well trained. One person told us,”The carers are really wonderful.” Another person said, “They always have training.” However, other evidence did not support this. We saw that some training had not been completed by all staff and some staff were in need of refresher training. Some staff had not had appraisals.

We saw people being spoken with appropriately. We saw that staff were kind, polite and respectful.