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Inspection carried out on 31 October 2017

During a routine inspection

This inspection visit took place on 31 October 2017 and was unannounced. The service was registered to provide accommodation for up to 50 people. At the time of our inspection, 50 people were using the service. Perton Manor is divided into two wings; the east wing accommodates people with complex mental health needs, the west wing accommodates people who are living with dementia and may have physical care needs and/or nursing needs. On our previous inspection on 30 March 2016 we rated the service as Good in all areas. On this inspection the service remains Good overall although Requires Improvement within our question, ‘Is this service effective?’

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 made everyday decisions about their care and staff helped them to understand the information they needed to make. However where people were unable to make decisions, how their capacity was assessed was not always clear and some decisions were being made by relatives when the person may have been able to make these decisions themselves. People had meals and drinks served using a dementia range crockery made from plastic. Although other ranges were available, people were not offered a choice of using standard crockery and cutlery.

People felt safe and where risks associated with their health and wellbeing had been identified, there were plans to manage those risks. Where restrictions to people’s liberty had been identified, an application to make this lawful had been made. Staff were trained in safeguarding and understood how to recognise and report any abuse. People received the right medicines at the right time and medicines were handled and managed safely.

Staff had the skills and knowledge to provide care for people and knew people well. People had a choice of what to eat and drink and specialist individual diets were catered for. The staff liaised with health care professionals to ensure that people received the specialist care they needed. People’s support plans reflected the care and support they needed and included advice from external professionals.

People had developed respectful relationships with the staff who were kind and caring in their approach. People’s privacy and dignity were respected and they were supported to be as independent as possible. People were supported to maintain relationships with people that were important to them and visitors were welcomed at the home.

People were able to take part in meaningful activities. The staff had thought of different ways people could express themselves and be involved in activities in the home and when out. People were encouraged to complain or raise concerns, and these were resolved to ensure improvements within the service.

There was strong leadership which promoted an open culture and staff understood their roles and responsibilities which helped the home to run smoothly. People could share their views about the service and this was used to understand what people liked and where improvements were needed.

The registered manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us and kept us informed us important events that happened at the service.

Inspection carried out on 30 March 2016

During a routine inspection

This inspection was unannounced and took place on 30 March 2016. The service was registered to provide accommodation for up to 50 people. At the time of our inspection, 49 people were using the service. Perton Manor is divided into two wings; the east wing accommodates people with complex mental health needs, the west wing accommodates people who are living with dementia and may have physical care needs and/or nursing needs.

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.

Our last inspection took place on 4 March 2015, and at that time we asked the provider to make improvements in the way they safeguarded people and protected them from harm. At this inspection, we found improvements had been made. Staff were aware of the different types of abuse that could happen and were confident in how to raise any concerns. We had also asked the provider to make improvements to ensure the way they checked the quality of the service was more effective. We also asked them to demonstrate how they would reduce the risks of incidents occurring. Again, we found that improvements had been made. We saw the provider had analysed information which resulted in reductions in incidents.

We found that risks to individual were managed and staff were skilled in protecting people from harm. Staff were aware of potential risks and supported people in a safe manner. There were enough staff to meet people’s needs and staff were recruited in a safe way. Medicines were managed safely and staff were trained to do this.

When people were not able to make decisions for themselves, we saw that capacity assessments had been completed and decisions about their care and support were made in their best interests. When people who lacked capacity were being restricted, the provider had ensured this authorised legally.

Staff had the knowledge and skills they needed to support people and meet their needs. People were supported to have sufficient to eat and drink and to maintain their health.

People were treated in a kind and caring way, and their dignity and privacy was promoted and respected. People were encouraged to be as independent as they could be and were encouraged to make decisions about their care and support. Relatives were also encouraged to be involved with the planning and review of people’s care.

Staff knew people well and supported people to take part in activities and follow their interests. People knew how to raise any issues or complaints and we saw the provider had dealt with these and people had been listened to.

People spoke positively about the home and felt it was managed well. They were also encouraged to share their experiences with the management team.

Inspection carried out on 04 March 2015

During a routine inspection

This inspection visit took place on 31 October 2017 and was unannounced. The service was registered to provide accommodation for up to 50 people. At the time of our inspection, 50 people were using the service. Perton Manor is divided into two wings; the east wing accommodates people with complex mental health needs, the west wing accommodates people who are living with dementia and may have physical care needs and/or nursing needs. On our previous inspection on 30 March 2016 we rated the service as Good in all areas. On this inspection the service remains Good overall although Requires Improvement within our question, ‘Is this service effective?’

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 made everyday decisions about their care and staff helped them to understand the information they needed to make. However where people were unable to make decisions, how their capacity was assessed was not always clear and some decisions were being made by relatives when the person may have been able to make these decisions themselves. People had meals and drinks served using a dementia range crockery made from plastic. Although other ranges were available, people were not offered a choice of using standard crockery and cutlery.

People felt safe and where risks associated with their health and wellbeing had been identified, there were plans to manage those risks. Where restrictions to people’s liberty had been identified, an application to make this lawful had been made. Staff were trained in safeguarding and understood how to recognise and report any abuse. People received the right medicines at the right time and medicines were handled and managed safely.

Staff had the skills and knowledge to provide care for people and knew people well. People had a choice of what to eat and drink and specialist individual diets were catered for. The staff liaised with health care professionals to ensure that people received the specialist care they needed. People’s support plans reflected the care and support they needed and included advice from external professionals.

People had developed respectful relationships with the staff who were kind and caring in their approach. People’s privacy and dignity were respected and they were supported to be as independent as possible. People were supported to maintain relationships with people that were important to them and visitors were welcomed at the home.

People were able to take part in meaningful activities. The staff had thought of different ways people could express themselves and be involved in activities in the home and when out. People were encouraged to complain or raise concerns, and these were resolved to ensure improvements within the service.

There was strong leadership which promoted an open culture and staff understood their roles and responsibilities which helped the home to run smoothly. People could share their views about the service and this was used to understand what people liked and where improvements were needed.

The registered manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us and kept us informed us important events that happened at the service.

Inspection carried out on 20 August 2014

During an inspection in response to concerns

We visited Perton Manor on a responsive inspection because we had received concerns about the health, safety and welfare of people who used the service. This inspection was unannounced which meant that the service did not know we were coming.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask –

Is the service safe?

Staff were in sufficient numbers during the day of this inspection so that people who required one to one support were supported.

Some staff were not following the providers training in the moving and handling of people who used the service.

We were aware that some concerns regarding the safety of some people who used the service had been referred to the local authority for further investigation.

Is the service responsive?

People’s care needs and level of risk had been assessed, some care plans and risk assessments had not been reviewed recently, some were out of date and did not sufficiently guide staff on people’s current care, treatment and support needs, which put people at risk of inappropriate care.

Is the service caring?

We spoke with visitors to the service. One person told us: “The carers are really nice; my relative’s basic care needs are met. But I worry that my relative does not get stimulation when I’m not here”.

Another visitor told us: “Most of the staff do a very good job in very difficult circumstances; I visit regularly to help care for my relative- I like to do this”.

Is the service effective?

People’s health and care needs were monitored, but the service did not consistently act on issues identified and this meant that people may not have the best possible outcomes and their health could deteriorate.

Is the service well led?

The registered manager of the service was away from the service at the time of this inspection. The clinical lead nurse was in charge of the service and supported us with the inspection.

The management and senior levels of the service had been reorganised and now included a clinical nurse lead, care and deputy care managers.

The service had recently introduced new systems to review the quality and safety of the service. From the findings of this inspection the previous systems for monitoring the quality of the service were ineffective. We have asked the provider to tell us how they will improve in this area.

Inspection carried out on 18 February 2014

During an inspection in response to concerns

Perton Manor is a relatively new service having been open since April 2013. We inspected Perton Manor on a responsive inspection as we had received information that people's care and welfare needs were not always being met by a sufficient amount of staff.

Most people who used the service had complex needs and limited communication skills. We observed their care, looked at their care records, spoke with staff and the managers as part of the inspection process.

We found that people's care and welfare needs were being met. A relative of a person who used the service told us: "They treat (X) with respect here".

We saw that generally staffing levels were appropriate to meet the needs of people who used the service.