The Manor 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. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to 25 people. At the time of our inspection there were 16 people living in the home.

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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection the service was rated, ‘Requires Improvement’. We found the provider did not have guidance in place for 'as required' medicines and arrangements were not in place to ensure decisions were made in people's best interests.

At the present inspection the service was ‘Good’.

Guidance was in place to ensure people received their medicines when required. Medicines were managed safely.

Where people were unable to make decisions arrangements had been made to ensure decisions were made in people's best interests.

Suitable quality checks were being completed and the provider had ensured that there were enough staff on duty. In addition, people told us that they received person-centred care.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. Background checks had been completed before new staff had been appointed.

There were arrangements to prevent and control infections and lessons had been learned when things had gone wrong.

Staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received person-centred care. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access limited activities and community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to in order to improve the quality of care. The provider was in the process of developing arrangements to support people at the end of their life.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. However notifications had not been sent to CQC regarding Deprivation of Liberty Safeguards. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been consulted about

This inspection took place on 11 January 2017 and was unannounced. The manor provides accommodation for people who require personal and nursing care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 25 people. At the time of our inspection there were 20 people living at the home.

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.

We saw medicines were handled and administered safely, however guidance was not in place for administration of as required (PRN) medicines such as paracetamol. It was not clear in the medicine administration records (MARs) whether or not people had been offered their PRN medicines

The provider had systems and processes in place to keep people safe. The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Best interests decisions did not detail what decisions people required support with. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

On the day of our inspection people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe from abuse.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. Risk assessments were completed in the residential home. People had access to healthcare professionals such as the GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. It was not easy for people to make choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to respond in a timely manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received regular support and supervision.

We saw that staff obtained people’s consent before providing care to them. People were provided with access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans were in place to address any issues which were identified. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

We carried out an unannounced comprehensive inspection of this service on 4 March 2015. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At the last inspection on 4 March 2015 we found that the provider was not meeting the standards of care we expect in relation to ensuring that appropriate arrangements for the management of medicines are in place. Infection control procedures did not protect people from the risk of infection and systems and processes were not in place for the monitoring and improvement of the service.

We undertook this focused inspection on 23 September 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. During this inspection on the 23 September 2015 we found the provider had made improvements in the areas we had identified.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Manor on our website at www.cqc.org.uk.

The Manor provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 25 people who require personal and nursing care. At the time of our inspection there were 21 people living at the home.

At the time of our inspection 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.

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. The provider had systems and processes in place to keep people safe.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The management and administration of medicines was in line with national guidance.

Arrangements were in place to monitor the quality of the service and make changes to the service in order to improve care.

This inspection took place on 4 March 2015 and was unannounced.

The Manor provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 25 people who require personal and nursing care. At the time of our inspection there were 20 people living at the home.

At the time of our inspection 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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that there were long periods of time when there was little staff interaction. However we observed that when staff did interact with people this was usually in a positive manner. People told us that they felt safe and well cared for. When we spoke with staff they were able to tell us about how to keep people safe. However medicines were not stored safely and infection control risks were not consistently managed and people were at risk of cross infection.

We saw that staff obtained people’s consent before providing care to them. The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and GP.

Staff responded in a timely and appropriate manner to people and people had their privacy and dignity considered. Staff were kind and sensitive to people when they were providing support. Staff had a good understanding of people’s needs. However people did not have access to activities and excursions to local facilities and experienced long periods of time without interaction from staff.

People were supported to eat enough to keep them healthy. People were offered drinks throughout the day but did not have open access to drinks during the day. People had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs.

Staff told us that they felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. However, the complaints process was not openly in view and was only available in written format, therefore not everyone was able to access this.

Audits were not carried out on a regular basis. Accidents and incidents were recorded and reviewed to ensure trends and patterns were identified. The provider had not informed us of two incidents which they are required by law to tell us about.

The summary is based on our observations during the inspection, speaking with three people who used the service, a relative and two staff who supported them. We also looked at three records in detail and carried out a Short Observational Framework for Inspection (SOFI). SOFI allows us to spend time observing people and to understand their experiences of care.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found-

Is the service caring?

We saw how members of staff treated people and we observed care. We saw that care was delivered effectively. When staff delivered care we found that it was provided in a kind and respectful manner.

When carrying out the SOFI we observed there were no negative interactions from staff with people during our period of observations.

When they supported people staff showed patience and we observed that they supported people at the person's own pace. We spoke with a relative who told us that they felt their relative was safe.

We spoke with three people who lived at the home. One person said, "Staff are lovely."

Is the service responsive?

We saw that people's individual physical, mental and social care and support needs were assessed and met by staff. This included people's individual choices and preferences as to how they liked to receive their care.

We observed that staff responded to people in a positive manner and respected their individual preferences. For example, staff provided people's preferred food.

We observed that staff obtained people's consent before they carried out any care.

People had access to other professionals such as GP and chiropodist's in order to meet their needs.

Is the service safe?

Risk assessments regarding people's care were carried out and measures were in place to minimise these risks.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards in place. Mental Capacity Act (2005) and Deprivation of Liberty Safeguards are laws which protect people who are unable to make decisions for themselves. At the time of our inspection no one was deprived of their liberty.

We found where people lacked mental capacity their best interests had been considered by staff.

The service was safe and areas within the home were clean. The home was well maintained therefore not putting people at unnecessary risk.

Our observations found that members of staff knew people's individual health and wellbeing needs. There was a process in place to ensure that staff were aware of people's changing needs.

Is the service effective?

We observed that staff responded to people's needs in a timely manner. When we spoke with people they told us that they did not have to wait long for staff to attend to them.

Arrangements were in place to ensure that people's physical health needs were met. For example, where people had specific issues with their health, such as the need for a catheter, the care plans included guidance on how to deliver the care.

Is the service well led?

Staff said that they felt supported and trained to safely do their job.

Quality assurance systems were in place and people were listened to. Staff told us that they felt able to raise issues and that these were acted upon by managers. We saw satisfaction surveys had been carried out with people who lived at the home and their relatives.

The provider had processes in place to manage complaints.

Arrangements were in place to ensure staff were updated and informed of changes in people's needs and working practices.

At the time of our inspection there were 15 people who used the service. As part of our inspection we spoke with three people who used the service. We also spoke with the cook, a care worker, the deputy manager and the registered manager.

We spoke with two relatives about their views. We observed the support given by staff to people who used the service. We also looked at records, including care plans for three people and carried out a tour of the building.

Records we saw showed Mental Capacity Act assessments were inadequate and 'best interest' procedures were not in place. Additionally the records showed that people's changing needs had not always been assessed which meant they may not have received care and support which met their needs.

We saw people being offered choices which were respected and responded to.

One person we spoke with who used the service said, “The staff are smashing, you can do as much as you want yourself, they keep you independent.”

People were protected against the risk of abuse. We saw the provider had a safeguarding policy and procedure in place and staff members we spoke with told us their training included safeguarding vulnerable adults. They told us they were also supported to obtain further qualifications relevant to their role.

We saw that there were systems in place to assess and monitor the quality of service provided. Staff and people we spoke with who used the service felt the home was well led.