This comprehensive inspection took place on 4 January 2019 and was unannounced.

The Manse 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. The service can accommodate up to nine people in one house.

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. Registering the Right Support CQC policy.

At the last comprehensive inspection in September 2016, the service was rated Good. At this inspection we found the service remained Good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Manse’ on our website at www.cqc.org.uk’

The service had a registered manager in post at the time of our inspection. 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 we spoke with all said they felt safe. Staff understood their roles and responsibilities to safeguard people from the risk of harm. Staff had been safely recruited and there were enough staff to meet people's needs.

Detailed risk management plans were in place to guide staff on the action to take to mitigate the identified risks.

People received their medicines in a safe manner and received good healthcare support. People received a nutritious and balanced diet and their dietary needs and choices were met.

The service was carrying our environmental improvements at the time of our visit. However, it was well maintained and clean. Infection control was adhered to by staff.

People were supported to make their own decisions and choices. Staff were knowledgeable and understood the principles of The Mental Capacity Act.

There were good systems in place to monitor incidents and accidents. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

People spoke positively about the relationships they had with the staff team. The atmosphere was relaxed, calm and friendly.

People were involved in developing their care plans, which were person-centred and kept under review. Staff respected people’s privacy and dignity and promoted their independence. There was a strong person-centred and caring culture in the home. (person-centred means that care is tailored to meet the needs and aspirations of each person, as an individual.) The vision of the service was shared by the management team and staff.

There was a varied and appropriate activity programme and people had regular access to the community.

The service had an open and inclusive culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service.

We saw that the registered provider and registered manager continued to effectively monitor and audit the quality and safety of the service and that people who used the service and their relatives were involved in the development of the home and were able to contribute ideas.

Further information is in the detailed findings below

The inspection was unannounced, and the inspection visit was carried out on 15 June 2016. The home was previously inspected in June 2014, where no breaches of legal requirements were identified.

The Manse is a 9 bed care home, providing care to adults with learning disabilities and who have additional support needs including autistic spectrum disorders and behaviour which challenges. The home offers its services on both a long stay and respite basis

The Manse is located in the Nether Edge area of Sheffield. It is in a quiet area, but within walking distance of shops, pubs and cafes. It is approximately two miles from the city centre.

At the time of the inspection the service 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 and associated Regulations about how the service is run.

During the inspection, we observed staff speaking with people with warmth and respect, and people’s dignity and privacy were upheld as staff carried out their duties. Staff had a good knowledge of people’s needs and preferences, and care plans were highly personalised and indicated that staff understood people’s needs well.

Staff had an understanding of the Mental Capacity Act and the procedures to follow should someone lack the capacity to give consent. There were appropriate arrangements in place for people to consent to their care and treatment.

Meals were designed to reflect people’s preferences. People were encouraged to contribute to meal planning and preparation, and we saw evidence of this taking place.

Staff were knowledgeable about how to keep people safe from the risks of harm or abuse, and were well trained in relation to this. However, we noted that when safeguarding incidents had occurred, the provider had failed to make appropriate notifications to the local authority or to CQC.

There were arrangements in place to regularly review people’s needs and preferences, so that their care could be changed if required.

There was a system in place for monitoring the quality of service people received, and for receiving feedback from people using the service and their relatives.

An adult social care inspector carried out this inspection. Information was gained by speaking with two people who lived at The Manse. Some people were unable to verbally communicate their views to us. In order to help us understand their experiences we sat and spent time in the lounge / dining area of the home. Our observations and conversations enabled us to see how staff interacted with people and to see how care was provided. Information was also gained by speaking with the registered manager and the two support workers on duty at the time of our inspection. We also reviewed the care plans of three people and a range of other relevant records.

We considered all the evidence we had gathered against the outcomes we inspected in order to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary incorporates what people using the service, their relatives and the staff told us, what we observed and the records we looked at :

- Is the service Safe?

Throughout our observations we noted that people appeared relaxed with the support workers on duty and happy with the way in which they were meeting their needs.

Both people spoken with during our inspection told us they felt, “safe” living at The Manse. One person attributed this to, “there always being somebody around to help you.”

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may lack capacity to make key decisions about their care and treatment. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty.

Whilst support workers were able to evidence how they involved people in day to day decisions, our conversations demonstrated a lack of knowledge about the Act and these key areas of practice. The provider's training matrix listed eleven members of staff. We found that five of these members of staff had last received MCA and DoLS training in January 2012. The remaining six members of staff had yet to receive this key training. We discussed our findings with the registered manager. They informed us they had recently purchased a series of training courses which included MCA and DoLS training and agreed to prioritise this as the next training course to be delivered to all staff.

We spoke with the registered manager about the MCA and the DoLS. We found they were knowledgeable about both processes. From the examples they provided, we were confident that they were familiar with when to use these key pieces of legislation.

Each support worker was able to describe good hand hygiene and the importance of this, as well as how they reduced the spread of infection. Support workers told us supplies of personal protective equipment such as gloves and aprons were always in stock to safely control and minimise the spread of infection when supporting people.

We found that staff had received, and were due to receive, further training about how to use equipment safely. Regular internal and external checks were undertaken to ensure equipment was properly maintained and serviced.

We found that The Manse had an effective process in place, and undertook necessary checks to ensure that employees were of good character, and had the skills and qualifications needed to provide safe and effective care to people.

-Is the service effective?

People's care records showed that care and treatment had been planned and delivered in a way that was intended to ensure people's safety and welfare. One person was proud of the fact that they had lost weight. They were complimentary about the support they had received from staff to support them with this and stated, “the staff helped me to lose weight by cooking healthy meals and going out for walks with me.”

We found that people were supported to access a range of social opportunities and community resources to meet their individual needs and interests. Some people attended day services whilst other people took part in activities arranged by The Manse. During our inspection visit we saw people joining in an ‘x-box’ karaoke session. The staff on duty supported people at their own pace and encouraged and praised people’s participation in this activity. People demonstrated their enjoyment by smiling, singing along and tapping their feet.

-Is the service caring?

Throughout our inspection the atmosphere at The Manse was calm, supportive and relaxed. We saw that people were provided with support when they needed or requested it. People appeared relaxed with the support workers on duty and seemed happy with the way in which they were meeting their needs. Our observations and conversations with support workers demonstrated they knew people well and were able to interpret the verbal and non-verbal ways people communicated in order to assess mood, behaviours and general wellbeing.

-Is the service responsive?

Observations on the day of our inspection showed us that The Manse appropriately responded and met people's individual care needs and requests. We saw that staff responded promptly to people's needs.

Our review of the surveys completed by relatives and our conversations with the two support workers on duty at the time of our inspection showed us the registered manager responded to any issues or concerns. For example, one relative had commented. “Anything which we are not happy about is not a problem to get sorted. I know I can phone anytime”. Support workers were similarly positive about the way in which the registered manager responded to, and dealt with any issues they raised. They also said there was an on-call system in place to respond to any concerns or issues which arose outside of the registered manager’s usual working hours.

Our conversations with the registered manager provided an example of the action they had taken in response to identifying that people’s rooms were not being cleaned to the standard she expected. A daily check-list of the tasks needed had been placed in each person’s room. Support workers initialled each task after completing it. Each check list was then reviewed each day by the registered manager. This showed us the registered manager had taken appropriate, responsive action to improve the standard of cleanliness at The Manse.

-Is the service well led?

We found The Manse had a system in place to monitor and review the quality of care provided and ensure this continued to meet people’s needs. The owner of the home undertook monthly quality assurance visits. We reviewed the record of the previous three visits and saw the template used incorporated key aspects of the service such as staff issues, accidents and incidents, feedback from people, staff and professionals. The owner’s visits also included a review of the regular audits undertaken by the registered manager.

Both support workers were complimentary about the registered manager. One support worker commented, “I’m very happy for her be my manager, she’s good at her job. She’s approachable and if I’ve got any concerns I can talk to her or write a letter and put it under her office door”.

We saw a suggestion box in the hallway of the home encouraging people to contribute any ideas, concerns or suggestions about how The Manse could improve the care and support they provided. We noted there was also an accessible, pictorial complaints policy and form in place for people living at The Manse. These documents demonstrated that The Manse actively sought involvement from people living at the home and their relatives in order to continually improve the quality of the service.

There were three people living at The Manse at the time of our inspection. We used a number of different methods to help us understand the experiences of people living at The Manse. This was because some people were unable to verbally communicate their experiences to us. We spoke with one person and sat and spent time in the large lounge / dining area of the home. This enabled us to see how staff interacted with people and to see how care was provided.

We found that people and /or their relatives had consented to and been involved in decisions about care and treatment. The registered manager had a clear understanding and practical experience of the processes to assess capacity and ensure any decisions made for people who lacked capacity were made in their best interest.

We saw that support plans were up-to, person centred and contained detailed information about people's support needs. We found that medicines were stored, dispensed, administered and recorded correctly.

One person told us that staff at The Manse were, “nice and pleasant to chat to.” Our observations demonstrated that there were enough suitably qualified staff to meet people’s needs.

We reviewed the one complaint received during the past year. This had been investigated and addressed appropriately. We saw that up-to date records of people’s health and social care needs were maintained and stored securely.

We spoke with one person who used the service about how they were involved in life at The Manse. They stated, “I choose what I want to eat for lunch and there’s a rota for evening meals.” In addition to choices about food, they also told us that they were offered a range of opportunities and choices about activities within the home and in the local community.

We spoke with the relatives of one person about care, treatment and support at The Manse. These relatives were confident in the way in which their family member was cared for and stated that their family member was, “well looked after." They had seen their family members support plan and felt that this reflected their needs.

One person who used the service told us that they felt safe living at the Manse. Our check of records and our discussions with staff demonstrated that The Manse were able to identify safeguarding issues and follow local procedures in order to safeguard people who used the service.

Our conversations with staff and our check of the training matrix evidenced that staff at The Manse were provided with appropriate training to enable them to carry out their roles and maintain their skills.

We also saw that The Manse had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care provided.

People with a learning disability and/or autistic spectrum disorder and/or a mental health need are not always able to tell us about their experiences, so we observed people in this inspection to help us understand. This involved people’s mood, how they interacted with staff members and other people who used services and their environment.

We did not see any facial expressions or body language that would indicate signs of unhappiness, distress or anxiety or fear with staff, but one person using the service displayed anger, threats and inappropriate behaviour towards staff.

We spoke with one person using the service and they told us they felt safe living there, but didn’t like it when another person that lived there hit staff and the other person living at the service.

There were two people currently using the service. We met and introduced ourselves to them and spoke with them to get their views of the service.

They told us they liked living at the home and that they got on well with staff. They told us they got their medication they needed and they got up and went to bed when they wished.

They told us the things they like to do and this included having their mobile phone, music, walking round on their own, cooking, shopping and ‘going to visit mum’.

One person was able to describe their routine for the day, which was in the main about household chores and meal times. The most important thing for them was access to the internet, but that this could be withdrawn unless they had complied with expectations about their behaviour.

They said they felt safe living at the service, but one person said they didn’t like it when the other person hit staff. They both said staff were kind to them.

When we spoke with one of the people using the service they were pleased that they had, had a male member of staff providing support.

There were two people who currently use the service. We met and introduced ourselves to them and spoke with them to get their views of the service.

They told us they enjoyed living at the home and that they get on well with staff. They told us they got their medication they needed and they got up and went to bed when they wished.

They told us the things they like to do and this included having their mobile phone, music, walking round on their own, board games, cooking, shopping and ‘going to visit mum’.

One person was able to describe their routine for the day, which was in the main about household chores and meal times. The most important thing for them was access to the internet, but, this could be withdrawn unless they had complied with expectations about their behaviour.

They said they felt safe living at the service and that staff were kind to them.

One person said their favourite place was their room.