This inspection took place on 5 and 6 June 2017 and was unannounced. The Manor House is registered to provide accommodation for people that require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury. At the time of our inspection there were 81people living at the service some of whom were living with dementia.

At the last inspection, the service was rated good. At this inspection we found the service remained good.

People receive support from staff that understood how to safeguard them from abuse and help them manage risks to their safety. There were sufficient safely recruited staff to meet people’s needs and maintain their safety. People received their medicines as prescribed and medicines were administered by trained staff that had their competency assessed.

People were supported by staff that understood their needs and had the required skills to meet them. People 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. People had a choice of food and drinks and support to meet their nutritional needs and preferences. People were supported to maintain their health and wellbeing.

People felt they had good relationships with staff and they told us they felt staff observed their rights to privacy and treated them with dignity and respect. People were given choices and were supported to maintain their independence.

People had their needs met in the way they preferred and were able to spend time doing things they enjoyed. People and their relatives understood how to make a complaint and we found complaints were managed in line with the provider’s complaints policy.

People, relatives and staff all told us the registered managers were approachable and they felt able to raise any concerns and make suggestions about the service. Staff said they received support in their role from the management team. The provider took opportunities to enhance the quality of the service people received through training and development for staff. We found there were systems in place to ensure people received good quality care.

This inspection took place on 12 November 2014 and was unannounced.

The Manor House Nursing Home is registered to provide accommodation for up to 82 people who require nursing or personal care. At the time of this inspection 78 people lived at the home.

The home 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.

Staff had received training in protecting people from harm and were clear about the actions they should take if they had suspicions that people were not safe.

Some people who used the service were unable to make certain decisions about their care. Staff were aware of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). Referrals were made for people who may have their liberty restricted.

Recruitment processes were in place to ensure only people suitable to work in care were employed. New staff completed a thorough induction programme before they started working on the units. Staff received training that was necessary for them to do their job.

People were involved in the planning of their care whenever possible. Where this is not possible, representatives were involved. Assessments were completed when people were at risk of harm.

Medication was managed safely and people received their medication when they needed it.

People were provided with a well-balanced diet. However, the mealtime experience should be reviewed so that people can enjoy their meal in a more pleasurable way.

People spent periods of time with little or no stimulation, recreational and leisure activities were not readily available. The recruitment for staff to support people with their hobbies and interests was on-going.

People were treated with dignity and respect. Staff were patient, caring and compassionate.

Complaints and concerns regarding the service were dealt with by the manager.

There was a registered manager and staff told us they felt well supported by the manager and the management team. We were informed of significant incidents and the action taken to reduce the risk of recurrence.

Systems were in place to monitor the quality of care being delivered. The manager had plans for improving the quality of the service provided and for the benefit of people living at the home.

This was a scheduled unannounced inspection. The service did not know we were visiting.

At the time of our inspection 78 people were living in the home. We spoke with staff, visitors and people that used the service who were able to tell us about their experiences. One person who used the service told us: "The staff are very attentive to our needs".

Some people were unable to speak with us either because of frailty or personal preference. We spent time in the units to observe the activity and interactions between staff and people who used the service.

We looked at the care and support records of nine people who were accommodated in different units within the home. We spoke with staff and they told us how they provided care for people each day. The information recorded in the plans corresponded with what staff had told us.

Staff told us their understanding of safeguarding vulnerable people and confirmed they had received training in this. People who used the service told us they did not have any concerns but if they did they would speak with the manager, senior staff or their family.

We saw staff were attentive and prompt when people required help and support. Staff told us that they had received training to help them understand how to meet the needs of people in their care. We saw people took part in a variety of activity that had been arranged during the day.

We saw that records included the care and support needs for the people who used the service.

During this inspection we saw that people and/or their representatives were supported to make decisions and were involved in the planning of their care. We saw that where people found it difficult to make decisions, systems were in place to support them.

We spoke with staff about the care and support they provided each day, they offered an explanation of people's individual needs. We looked at a selection of care records to check the care being given to people. We saw some inconsistencies in the recording of people's care needs, some records had not been reviewed or updated within the specified timeframe. People we spoke with told us the care they received was good, they had no concerns. Visitors told us the care provided to their relative was "excellent".

We spoke with staff about their understanding of safeguarding vulnerable adults, they told us what they would do if they had any suspicions of wrong doings. People told us they would speak with staff or a family member if they had any concerns about the care they received.

We saw that staff were present in all areas of the home, they were quick to offer help and support to people when it was needed. People who used the service told us that the staff were very good and helpful. Visitors told us they were fully satisfied with the staff and the way in which the care was provided to their relative.

We saw the service had an effective system for monitoring the quality of the service.

We carried out this inspection visit because we had received concerns about the organisational process for safeguarding vulnerable adults from the risk of abuse. We did not have enough information to assess whether the service was compliant with Regulation 11, Safeguarding service users from abuse. The local authority had raised these concerns with CQC and the homes manager.

The Health and Social Care Act 2008 states that a registered person must notify CQC without delay regarding specific incidents, for example allegations of abuse of a person using the service. There is also a requirement for an organisation to refer allegations or concerns to the local authority safeguarding service.

There had been two incidents within the home in the last month that had not been appropriately reported to CQC or the local authority safeguarding service. There is also a requirement to report injuries, diseases and dangerous occurrences (RIDDOR) to the Health and Safety Executive. We did see that the service reported RIDDOR appropriately.

We looked at policies within the home for safeguarding vulnerable adults and the accident/incident reporting process. We found there had been failings to follow organisational polices when managing allegations of abuse and incident reporting.