The inspection took place on 19 February and was unannounced. The inspection continued 20 February 2018 and was announced.

Steepleton 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.

Steepleton Manor Care Home is a large detached period property in Winterbourne Steepleton. The home provides long term and respite accommodation for up to 30 older people with personal care and nursing care needs. At the time of our inspection 22 people were living at the home.

Our last inspection on 19 September 2016 we found that systems and processes in place to assess, monitor and improve the service were ineffective. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question well led. We found that during this inspection the action plan had been followed and improvements had been made.

The service had 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, relatives, a health professionals and staff told us that Steepleton Manor was a safe home. Safeguarding alerts were being managed and lessons learnt by the home. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines.

People were supported by staff who understood the risks they faced and valued their right to live full lives. Risk assessments in relation to people’s care and treatment were completed, regularly reviewed and up to date.

There were sufficient numbers of safely recruited staff at the home. A dependency tool was used to calculate the number of staff hours required to meet people’s needs.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had a care plan and associated files which included guidelines to make sure staff supported people in a way they preferred. Staff were able to access care plans and guidance on the go by using hand held devices.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were diabetic and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Improvements had been made in relation to the completion and assessment of capacity assessments and best interest decisions.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, district nurses and a chiropodist.

People, professionals and relatives told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortab

Steepleton Manor Care Home was last inspected on17 and 22 July 2015. At that inspection we found that the provider needed to make improvements in the risks people faced and ensuing improvements were made in the way the service developed.

Steepleton Manor Care Home provides accommodation and nursing and personal care for up to 30 older people. There were 18 people living there when we visited.

There was a registered manager in place. 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 provider was meeting the requirements of the Mental Capacity Act 2005. Staff understood some of the concepts of the Act, such as allowing people to make decisions for themselves.

The provider had systems in place to ensure the quality of the service was regularly reviewed but this was not consistently applied which meant that some peoples care records required updating.

Staff lacked guidance with relation to some of the tasks they were required to do. The management did not give staff clear guidance on how to complete some tasks such as close observation of people.

People were not consistently offered choices at mealtimes such as where to sit and what to eat, the system for obtaining peoples choices was ineffective as it failed to take into account some people’s memory problems.

Staff told us they felt supported by the management and they felt their opinions were valued.

Staff knew people’s needs and the care records generally supported their comments. One person told us "staff help me with washing and dressing, they know my needs and my daily routines. I am well looked after, sometimes they (staff) sit and chat when I go to the lounge”. Another person told us “ the staff a good to me and never rush, a great place to stay”. A relative told us that they felt involved in arrangements made for their loved one.

Staff demonstrated a caring and compassionate approach to people living at the home. People told us there were enough staff to meet their needs, our observations confirmed this.

Staff told us they worked well as a team and enjoyed working at the home.

We found a breache of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.

During our inspection we were unable to speak with some people who live in the home due to their complex needs. We spoke with three people who live in the home. People told us that their agreement was sought prior to staff supporting them with their care needs. A person told us, "They always ask before they do anything.” We found that the home had appropriate procedures around the assessment and recording of people's mental capacity.

We found that people's needs were assessed and care was planned and delivered to meet people's needs. A person told us, "I’m aware that I have a care plan. I have been invited to look at the write up and give my opinion." Another person told us, “The care here is second to none.”

We saw that the home was clean and well presented, and that people were protected from the risk of healthcare associated infections. A person who lives in the home told us, "They clean my room every day."

We found that staff were knowledgable about people's needs. We also found that staff were supported to provide care and treatment to people. A person told us, “The head of care is very good. She explains things not only to me, but also explains things to the staff."

We viewed six people's care records and found that the home had not maintained each person's personal care record appropriately. We also found that people’s personal care records and personal information were not stored securely at all times.

During our visit to Steepleton Manor Care Home on 12 March 2013, we spoke with seven people who used the service. They were all very complimentary about the care they received. One person said, "Everyone is so willing and helpful." Another person said of the staff team, "No one has ever said it is not my job, they are a team."

We reviewed the care records for three people currently living at the home and saw that they were offered care that ensured their specific individual needs were met.

The service provided a wide range of activities for people and the home had access to a mini bus twice a week. People told us they enjoyed a variety of trips out to local events and establishments such as garden centres and public houses.

People who used the service told us that the staff managed their medications and they were happy with the systems. We saw robust policies in place for the administration of medication, but did note that sometimes the staff did not document the correct code when they omitted a medication because a person stated they did not want to take it.

People told us and the duty rotas confirmed that there was always sufficient staff on duty. One person said, "If you need someone there is always a member of staff to help." A relative of a person using the service said, "The staff are very supportive. I am very pleased with the care here."

People were generally very positive about their experience of living at the home. One person told us that nothing was too much trouble for staff and that the care was marvellous. They said that staff always knocked on the door before entering, and they explained everything. During our visit we observed staff communicating sensitively with people, asking their preferences and listening to them.

People we spoke with told us that they were involved in reviewing their care plan. However, people who did not need a lot of support with their personal care told us they would welcome the opportunity to discuss their needs and wishes on a more regular basis.

We saw that all residents were given a written copy of the activities planned for the month and staff reminded them of activities available on the day. One person told us there was plenty to do; they were not pushed to join in and always had the choice.

Some people, we spoke with, were disappointed that they had not had the opportunity to go out of the home for several months. They told us that they used to go out a lot in the mini bus but had not been out over the summer. They were aware of activities at the home but hadn’t been asked their individual preferences about outings. The home had a vacancy for an activities coordinator and had not been able to recruit someone able to drive the min bus for outings.

People we spoke with thought that there were enough staff to support their needs. They told us that at busy times in the morning staff were sometimes rushed and there were some delays to call bells being answered. We observed a registered nurse and five care workers on duty caring for people. They were supported by the manager, an administrator, a chef, maintenance man, housekeeper and two support workers, who undertook cleaning duties and assisted with meals. The home had a vacancy for an activities coordinator and there was nobody to drive the mini bus for outings.

People told us that they felt safe at the home and they knew who to go to with any concerns. They told us that they valued the residents meetings, but there had not been a meeting since August. Some people told us they had completed a questionnaire about their experience of the home, but were waiting for feedback on the results.

Steepleton Manor Care Home was last inspected on 11 November 2014. The home was found not to be meeting all requirements in the areas inspected. We told the provider that improvements were required in the standard of record keeping, the quality assurance auditing and the arrangements to establish consent or to act in people’s best interests. We were also concerned that there was insufficient staff to meet people’s needs, that the staff employed had not undergone the necessary checks to ensure their suitability to work at the home and people were not treated with consideration and respect.

The provider wrote to us and told us the necessary improvements would be completed by 8 April 2015. We found that the necessary improvements had been made.

Steepleton Manor Care Home provides accommodation, nursing and personal care for up to 30 older people. There were 24 people living at the home there when we visited.

There was no registered manager in place, however a manager had been appointed and had applied for registration with the Care Quality Commission. The application was in the latter stages of the approval process. 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 provider was meeting the requirements of the Mental Capacity Act 2005 but further improvements could be made in the assessments of people’s mental capacity. The manager was aware of this and took steps to make these improvements during the course of the inspection, in-between the two inspection dates. Staff understood some of the concepts of the Act, such as allowing people to make decisions for themselves.

The risks people took were understood by staff and in general terms had guidance on reducing those risks. The risks people took had been reviewed and updated. We found that one person’s risk assessment could be improved; the management acknowledged this and took steps to further review the person care records.

The provider had systems in place to ensure the quality of the service was regularly reviewed and improvements made. The new management at the home were developing an open culture through regular meetings with the people living there and people important to them. The staff told us they felt supported by the management and that their opinions were valued.

The staff knew people’s needs well and the care records reflected their comments. One person told us, “they (staff) help them with things I find difficulty with such as tying their shoes” saying “they do just enough, too much and I might become lazy, I have no complaints”. Another person told us “I don’t rely on staff much, but they are always there when I need them, they’re kind and listen to me, sometimes they have time to sit and talk and share a cup of tea which is nice”.

The staff demonstrated a caring and compassionate approach to people living at the home. People were offered choices at mealtimes such as where to sit and what to eat. The provider had a system to offer a choice of food during mealtimes that was effective.

People told us there were enough staff to meet their needs and our observations confirmed this. The provider was able to demonstrate that extra staff were available to support people should their needs change or if extra support was required.

The staff told us they worked well as a team and enjoyed working at the home. They told us things had improved and there was now some flexibility within their working hours to sit and talk with people and to do things with them that they knew interested them.