The Manor provides nursing care and accommodation for up to 86 people. It is arranged over two floors and divided into three units. Hestercombe on the ground floor provides care to older people and the two units on the first floor, Victoria and Vivary provide care and to older people and working age people who have nursing care needs.

At the time of the inspection there were 52 people living at the home.

At the last comprehensive inspection in February 2015 the service was rated good. Following concerns a focussed inspection was carried out in May 2015 and two requirement notices were issued. At the inspection in May 2015 we found that people were not always treated with respect and dignity because language used by staff was not always appropriate. We also found that no care plan was in place for a person with specific needs around their swearing. At this inspection we found these issues had been addressed. All staff interactions we heard on the day of inspection were polite and respectful. We also found that specific care plans were in place to meet people’s individual needs.

At this inspection we found the service remained Good.

Why the service is rated Good

People were safe at the home because there were adequate numbers of suitable staff to support them. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. People received their medicines safely.

Staff had the skills and knowledge required to effectively meet people’s needs. People’s health was monitored by the staff and people had access to healthcare professionals according to their individual needs. 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.

Improvements had been made to ensure people were always treated with respect and dignity. People told us staff were always kind and polite. People or their representatives were involved in decisions about their care and support.

The service was responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Complaints were fully investigated and responded to.

People benefitted from a service which was well led. The provider had systems in place which sought people’s views and continually audited practice. Staff felt well supported by the management team which helped to create a relaxed and happy atmosphere for people to live in.

We carried out this inspection on 29 May 2015 and it was unannounced. The inspection was carried out to focus on concerns we received since our last inspection. The concerns were that people were not always treated in a dignified and respectful manner and that there were insufficient supplies of disposable protective clothing for staff. The concerns related to the unit for younger people with complex health needs.

The Manor is situated in the village of Bishops Hull which is not far from the town of Taunton. The Manor is a purpose built home which benefits from spacious and airy accommodation. The home can accommodate up to 86 people and is divided into three units. The ground floor provides nursing care to older/frail people. One of the units on the first floor provides nursing care to younger people with complex needs the other provides nursing care to people who have a physical disability and/or mental health needs. The home is staffed 24 hours a day and registered nurses are on duty at all times.

We carried out an unannounced comprehensive inspection of this service on 11 February 2015. After that inspection we received concerns in relation to staff swearing at and in front of people living in the home. Staff providing personal care in an undignified way that lacked respect to the individual. Poor provision of protective clothing such as gloves and aprons for staff to use whilst providing personal care. As a result we undertook this inspection to make sure people were receiving care that was safe and caring. We also raised a safeguarding alert to the local authority who take the lead in investigating safeguarding. This report only covers our findings in relation to the concerns we received. 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.

There is 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 there was a culture of swearing in the home. This was inappropriate and failed to respect people. We were told this was more in friendly banter with people living in the home who also swore. However some staff indicated it was more of a cultural issue with staff who did not recognise swearing as a problem. Some staff felt this was mainly through having a team of younger staff working together. The manager was in the process of reviewing staff on the unit so there was a mix of younger and more mature staff.

Part of the concern stated a person was wheeled in their chair to the shower only covered with a small towel. We found there was not enough evidence to substantiate people had been treated in this way. All staff spoken with said they would report any incidents if they felt they were inappropriate. One staff member said, “If I witnessed anything like that I would tell them myself then report it to the manager.” People said they felt well cared for and a relative said they were happy with the care in the home.

We discussed the allegations with the registered manager they immediately agreed to investigate in line with their complaints policy and liaise with Somerset safeguarding team and the Care Quality Commission.

Staff had received training in identifying and reporting abuse. Staff were able to explain to us the signs of abuse and how they would report any concerns they had. They stated they were confident any concerns brought to the manager would be dealt with appropriately.

There were adequate supplies of protective clothing in place for staff to use the store cupboard was well stocked and all staff had access.

We observed there were adequate staffing levels on each shift. Staff confirmed staffing levels could be flexible to meet the care needs of people and to support other staff. We observed staff took the time to chat and socialise with people and call bells were answered promptly.

Risks to people had been identified and there were systems in place to minimise the risk as far as possible. Staff were aware of the risks and followed people’s care plans to ensure they were safe.

People received their medicines when they needed them. There were procedures in place for the safe management and administration of people’s medicines; these were followed by staff. Medicines were only administered by registered nurses.

We found two 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.

There were 68 people living in the home when we visited. We spoke with 15 people, one visiting relative and 17 members of staff. We also observed the care provided to other people who were unable to communicate verbally.

We observed staff spoke with people in a kind and respectful manner. One person said “The staff are all very friendly, they talk to you like an equal”. People received personal care in the privacy of their own room which promoted their dignity. One person said “The staff are always gentle and respectful when they help you”.

People were happy with the care they received. Comments included; “I feel well cared for” and “We are all really well looked after”. A visiting relative of a person with complex care needs said “X seems very happy and contented”.

All areas of the home we visited were clean and fresh. One person said “The cleaning staff are excellent”. We found effective systems were in place to reduce the risk and spread of infection.

People’s medicines were administered by qualified nurses. Records had a photograph of the individual and information about the assistance they required to take their medicines. This minimised the risks of medication being given to the wrong person and ensured people received adequate support.

Staff had the skills and qualifications to meet people’s needs. Care staff said they were well supported by the manager, nurses, senior care staff and other colleagues.

We spoke with 16 people who lived in different parts of the home, two visitors and 11 members of staff. We also observed people’s care to understand the experience of those who were unable to talk with us.

People told us that they were asked for their consent and the provider acted in accordance with their wishes. People said, “Staff always ask me what I want to do and respect my decisions” and “Staff always talk to me about my care, I feel very involved”. Regular meetings were held with people and their families and best interest decisions were made on behalf of people who lacked the ability to understand their care or treatment.

The majority of people were happy with the care provided. People said, “I love living here, I love the mixture of people”, “I’m taken care of so excellently” and ”Staff are kind and caring they treat me so well”.

There was a programme of group and individual activities for people to participate in. People told us, “I love the activities and can choose to join in or not” and “I enjoy the range of activities”.

We found appropriate arrangements were in place in relation to obtaining, recording and disposal of people’s medicines.

People told us, “There are usually enough staff. If I ring my buzzer they come within a few minutes” and “Staff are very good and generally they come quickly”.

We found complaints were fully investigated and resolved where possible to people’s satisfaction.

Staff treated people in a kind, respectful and patient manner we were told “Staff are so kind and thoughtful”. People said that the staff always respected their privacy by knocking on doors before entering and staff ensured their doors were closed when they were assisted with personal care. When people needed assistance with their meals staff were seen and heard to provide this in an appropriate, kind and reassuring way.

People could attend the home’s ‘Thursday club’ where they discussed how the home was run, were able to raise concerns and gave opinions on menu choices, the food and activities. We were told “There is always something going on in the home if you want to join in” and “We have outside entertainers and regular trips out”.

People said they were happy with the care and support they received. Comments included, “I feel very well looked after here” and “I can’t fault the care it is wonderful”. We observed that although staff were busy they did not rush people and the atmosphere throughout the home was calm and relaxed. People said they felt listened to and that staff always responded to their needs. We were told, “If I was worried about anything I know that staff would sort it out for me” and “I am so happy living here because I know I am safe because the staff check on me all of the time”.

We also spoke with some of the relatives of people in the home. One relative told us their spouse was, “very well cared for and I am perfectly happy with the staff. The care leaves nothing to be desired” and ”Staff are always there for us and they give the best possible care”. Another relative said, “Sometimes the care is excellent but it can be inconsistent”.

Overall people living in the home and their relatives were very complimentary about the quality of service provided at The Manor. We were told, “It’s like a first class hotel” and “This is the fourth home my relative has been in and it is by far the best”.

This inspection took place on 24 and 26 February 2015 and was an unannounced inspection.

At the last inspection carried out on 2 January 2014 we did not identify any concerns with the care provided to people.

The Manor is situated in the village of Bishops Hull which is not far from the town of Taunton. The Manor is a purpose built home which benefits from spacious and airy accommodation. The home can accommodate up to 86 people and is divided into three units. The ground floor provides nursing care to older/frail people. One of the units on the first floor provides nursing care to younger people with complex needs the other provides nursing care to people who have a physical disability and/or mental health needs. The home is staffed 24 hours a day and registered nurses are on duty at all times.

There is 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.

Staff talked with pride and enthusiasm about the home and its ethos of care and support for the people who lived there. Staff told us how each person was supported to achieve their full potential and people always came first. Staff told us the home was well run and they could always approach the registered manager and/or the deputy manager and know they would be listened to if they had any concerns

The majority of the people who lived at the home were very frail or had very complex health care needs and required staff assistance with all aspects of their life. Some people were nursed in bed. Staff were professional, kind and caring when interacting with people. They knew about people’s needs and preferences and had received the necessary training to meet people’s needs.

People were complimentary about the care they received and of the staff who supported them. One person said “I need help with just about everything. All the staff from the bottom up are fantastic. They certainly know what they are doing.” Another person said “The staff are confident and very professional in every way. I feel very well cared for.” A visitor told us “I am aware the staff here get lots of training. I would say they are very competent.”

There were sufficient numbers of staff to meet the needs of the people who lived there. People were provided with opportunities for social stimulation and trips out. Designated activity staff were available seven days a week and activities were tailored to meet the needs and preferences of the people who lived at the home.

People could see their doctor or other health care professionals when they needed to. People were also supported to attend hospital appointments. The care plans we read showed that staff followed any recommendations made by health care professionals. One person told us “They are very good. They don’t hesitate in calling the doctor if you are unwell.” Another person said “I have to go to the hospital for regular appointments. The staff let me know and someone always comes with me. It’s a first class service.”

People were treated with dignity and respect and they were supported to make choices about how they spent their day. A visitor told us “The staff are always kind, caring and respectful. I have only heard them talk to people in a very ompassionate and respectful manner. They seem to know everybody really well.” Another said “They are my angels. They never force my [relative] to do anything. They know what is important to my [relative]. They take care to make sure my [relative] is smart and co-ordinated. That shows they care.”

People’s dietary needs were catered for and their nutritional needs were met. People were very positive about the quality and choice of the meals and drinks available to them. One person said “The food is what you would get in a five star hotel but even better as you can have anything you want. You always have a choice and if there is something you don’t like they will always do something different for you.”

Staff knew how to recognise and report abuse. They said they would not hesitate in reporting any signs or allegations of abuse to make sure people were safe. People’s rights were protected because staff had the knowledge on action to take if someone lacked capacity to consent to their care and treatment.

People could see their visitors whenever they wished. This was confirmed by people who lived at the home and visitors. One person told us “My family are important to me so it is comforting to know they can visit at any time.” A visitor said “They couldn’t be more welcoming or accommodating when we visit.”