This inspection took place on 8 and 10 January 2019 and was unannounced.

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.

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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The values that underpin Registering the Right Support and other best practice guidance were seen in practice at this service. There was overwhelming evidence that the core values of choice, promotion of independence and community inclusion; were at the centre of people's day to day support. Staff were extremely person centred in their approach in supporting people with their day to day goals and their long-term aspirations.

However, the service was a large manor house, which was larger than most domestic style properties and was registered to support up to 23 people. There were 16 people living permanently in the service and seven people living at the service for short breaks. This service is larger than current best practice guidance. The registered manager and provider had reduced the negative impact on people in the following ways. The design of the building was such that it fits into its environment, as it was in a residential road with other large domestic homes of a similar size.

The home had been divided into three separate units, Chestnuts, Arandell and Beechwood supporting people in smaller groups of six and eight. Each unit had their own communal space consisting of a lounge, kitchenette and dining facilities and bathrooms. There were also additional shared areas which people could use to their benefit, such as an arts and crafts room, a central lounge and a sensory room, large gardens including a sensory garden. In addition to their very personalised bedrooms.

Staff were allocated to each unit enabling them to support people in a very person-centred way. People had a high level of autonomy over how they spent their time. People's support was built around them and this enabled people to live individualised lifestyles. There was a calm welcoming atmosphere in the home. It did not feel overly busy or institutionalised.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment and fire systems.

People received extremely effective care because staff had the skills and knowledge required to support them in a very person centred way. People's healthcare needs were monitored by the staff. The service was commended by health care professionals on their person centred approach. Staff knew people very well and noticed slight changes in people which might indicate that they were not well or unhappy.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked

The Manor House - Frenchay is registered to provide accommodation and personal care for up to 32 people. However shared rooms were no longer in use so the registered manager told us now a maximum of 23 people would be accommodated. People who live at the home have a learning disability and, or a physical disability. There were 17 people accommodated at the time of the inspection. There were six short stay beds which were regularly used by 13 people who lived in the community and required respite care for short periods of time. The home was split into three different areas Chestnuts, Beechwood and Arandell. Chestnuts and Beechwood supported people with physical disabilities and Arandell was supporting people who were mobile and more independent.

This was an unannounced inspection, which meant the staff and provider did not know we would be visiting. This inspector took place on the 7 and 8 June 2016.

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 had a care plan that clearly described how they wanted to be supported. These were tailored to the person. Care was effective and responsive to people’s changing needs. People had access to healthcare professionals when they became unwell or required specialist equipment. People received their medicines safely. People were supported with maintaining contact with family and friends in many different ways. This was seen as important by all the staff and the registered manager. Families were made to feel welcome and invited to social functions held in the home throughout the year. The staff were extremely caring which promoted a friendly and welcoming atmosphere. From talking with staff, the registered manager and relatives it was evident the staff went the extra mile to ensure people led the life they wanted to lead. A member of staff had been put forward for the local Care Awards to acknowledge their commitment to supporting people. There were no barriers for people in respect of the activities they took part in.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these procedures. Systems were in place to ensure people were safe. These included risk management, checks on the environment and safe recruitment processes. Staff knew what to do to keep people safe.

People’s rights were upheld and they were involved in decisions about their care and support. Where decisions were more complex these had been discussed with relatives and other health care professionals to ensure it was in the person’s best interest. Staff were knowledgeable about legislation to protect people in relation to making decisions and safeguards in respect of deprivation of liberty safeguards. Appropriate applications had been made in respect of these safeguards ensuring people were protected.

Sufficient staff supported the people living at the service. Staffing was planned flexibly to meet people’s needs. Staffing was kept under review when people stayed for short breaks. Staff had received appropriate training to enable them to respond to people’s needs effectively. Staff were supported in their role and received regular supervisions. Supervisions are where a member of staff meets with a senior manager to discuss their role, performance and training needs. There was clear communication that enabled the staff to be responsive to people’s ongoing and changing needs.

Systems were in place to ensure that any complaints were responded to. People’s views were sought through an annual survey, care reviews and resident meetings.

The registered manager and the provid

The home supported people who used the service with a wide range of needs, including physical and behavioural support and communication needs. We used a number of different methods to help us understand the experiences of people including talking with the registered manager and staff and looking at records. We joined a midday meal and spoke with several people who told us they had returned from a bowling activity that they had enjoyed.

To help understand the experiences of people who were unable to tell us verbally we carried out observations of staff interaction. It was evident from these observations that people were treated with warmth and respect and that staff engaged with people in a positive way. Staff knew how to report suspected abuse and allegations of abuse had been reported to the appropriate agencies.

Care plans recorded peoples' individual care needs, preferences and their health needs. People were given appropriate information and support regarding their care or treatment, and supported to make decisions about their lifestyle.

Staff were supported to deliver care and treatment safely and to an appropriate standard through clear processes of induction, training and supervision.

There were systems in place that monitored all aspects of the quality of the service on a regular basis. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

We spent time in various parts of the home, including communal areas and individual bedrooms so that we could observe the direct care, attention and support that people received. People were happy. In parts of the home the atmosphere was calm and relaxed and in other parts busy and lively.

People living in the home were spending time as they wished during the day of our visit. Some people were out, others relaxed in the communal rooms, their own rooms and took part in activities in the games room.

We were introduced to people throughout the day and they welcomed us to their home. They talked freely with staff in front of us and people were confident and assertive in their surroundings.

There was a happy, relaxed atmosphere in the home. We saw staff interact in a caring way and people living at home responded to this. Staff were confident and knowledgeable about people's past social and medical history and what care and support they required.

Their passion, knowledge and enthusiasm of the service and the people in their care was evident. Staff morale was positive and they were 'proud' of the service they provided as a team so that the quality and safety of people was maintained.