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Inspection carried out on 10 December 2018

During an inspection to make sure that the improvements required had been made

Spetisbury Manor is a large converted property set in spacious well-maintained grounds providing residential care for up to 25 older people. 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.

At the time of this inspection there were 11 people accommodated at the home. The service had been without a registered manager for nine and a half months; however, a new manager had been appointed. They had just finished their 5 week induction and were in the process of registering to become 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.

This focused, unannounced inspection was carried out on 10 December 2018 by two inspectors. The inspection was carried out because concerns had been raised about the management of the home and the care people received. The concerns were not substantiated at this inspection, although some areas for improvement were identified. The management team took immediate action to address the issues we identified.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

The management team had systems in place that ensured most aspects of safety were addressed to promote safety in the home. Some hazards were identified during the inspection and the management took immediate action to address these.

The delivery of people's care had also been risk assessed to make this as safe for people as possible.

Staff were recruited in line with robust policies and all the necessary checks had been carried out by close of the inspection.

Medicines were well-managed and people received their medicines as prescribed by their doctor.

Staff had received training in safeguarding and were aware of their responsibility to report concerns.

Records we asked to see during the inspection were up to date and readily available on request.

Since the last inspection, the registered manager had ceased working at the home and a new manager had been appointed. They were in the process of registering to become registered manager and had kept us informed of progress. The period when there was no registered manager in post had led to some lack of leadership and instability in the running of the home.

There were auditing and monitoring systems in place seeking overall improvement. These could be improved to ensure that all areas of safety were addressed and actioned.

Inspection carried out on 12 June 2017

During a routine inspection

The inspection took place on the 12 June 2017 and was unannounced. The inspection continued on the 13 June 2017 on an announced basis. The previous inspection had been carried out in April 2015.

Spetisbury Manor is registered to provide accommodation for up to 26 people who require personal care. At the time of our inspection there were 16 older people living at the service. The home provides single room accommodation over two floors with the facilities to provide shared accommodation when required. Rooms have en-suite facilities and there is also a specialist bathroom on each floor.

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 were at risk of not having their topical creams administered safely. Cream prescription labels were not always clear, medicine administration records did not always match the creams prescribed, had not always been completed by staff and information was not available on where or how to apply creams to people. Medicine audits had been completed and included all other areas of medicine administration but had not included checking the recording and administration of topical creams. Where improvements had been identified an action plan had beencompleted, discussed with staff and better outcomes had been achieved for people. The registered manager agreed this was an area that required improvement and told us they would review the topical cream process and medicine audit tool immediately.

People and their families felt the care was safe. Staff had been trained to recognise signs of abuse and knew how to raise concerns. People were involved in decisions about their assessed risks and staff understood their role in minimising identified risk whilst respecting people’s freedoms and choices.

People were supported by enough suitably trained staff to meet their assessed needs. The registered manager told us they would source a staff dependency tool to assist in calculating staffing levels based on the changing needs of people and new admissions. Staff had been recruited safely with checks made to ensure they were suitable to work with vulnerable people. Induction and on going training provided staff with the skills to carry out their roles effectively. Staff received support through supervisions and appraisals with opportunities for professional development.

People had been 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 and their families described the staff as kind, caring, friendly and willing to help. Staff had a good knowledge of people, their interests, likes and dislikes and family and friends important to them. This was reflected in positive interactions between staff and people. People were involved in decisions about their day and felt their dignity, privacy and independence was respected. People’s individual eating and drinking needs were met and the mealtime experience was relaxed and at the persons pace.

People had their care and support needs assessed and reviewed regularly. Staff understood their role in supporting people whilst respecting the persons wishes and promoting independence. People had access to healthcare when it was needed. A range of activities was available to people including events linked with the local community.

The service was well led. Staff had a good understanding of their roles and responsibilities. Interaction between staff and the management was professional and communication effective. Feedback from people, their families and staff was had bee

Inspection carried out on 28 April 2015

During a routine inspection

This inspection took place on the 28 April 2015 and was unannounced.

Spetisbury Manor is situated in the village of Spetisbury, a short drive from Blandford Forum. The service is registered to provide accommodation and personal care for up to 25 people, it does not provide nursing care. At the time of our visit there were 15 people living in the service and three people staying for ‘respite’ short stay.

At the time of our inspection there was not 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.

The registered manager had left the home the week before our inspection and the vacancy had been advertised. The deputy manager was covering the role with support from the provider, people and staff expressed confidence in the interim management arrangements. The service was welcoming and people spoke openly about their experiences. People told us they liked living in the service and felt well cared for.

Staff had sufficient training to support them to do their job and staff were able to tell us how to recognise potential/actual abuse and what actions to take.

People told us the call bell system was not accessible in communal areas for people who are unable to mobilise however the provider was already aware of this and it was under review and different call systems were being sourced.

People were supported to make decisions about their lives. Where people did not have the mental capacity to make certain decisions, appropriate action was taken to ensure their rights were upheld.

Medicines were not always stored safely and the Medication Administration Records (MAR) were not always readable. The deputy manager was informed and she arranged for the pharmacist to visit that day and the charts were re-formatted. The MAR were made easily readable and the issue was resolved.

The provider had not completed a notification as required, to inform the Care Quality Commission of an incident of potential abuse.

Inspection carried out on 14 September 2013

During a routine inspection

People told us their needs were met. We spoke with ten people. They all told us that their care needs were met. One person told us that the staff “do everything I need.” Three people told us they were well looked after. One person told us “I am very happy here.” People had access to activities.

There were sufficient staff and staff received appropriate training, supervision and appraisal.

There were effective systems in place to handle complaints.

Inspection carried out on 25 March 2013

During a routine inspection

Spetisbury Manor comprises of 16 single rooms, three double rooms and three suites. They care for people who are self funded, funded by social services or continuing care teams.

We spoke with seven people who lived at Spetisbury Manor. They said that staff looked after them well and said that they were comfortable. We spoke with the registered manager, the deputy manager and two members of staff. We also spoke with two relatives of a person living at the home.

Spetisbury Manor has recently enrolled in the 'Gold Standards Framework' an approach to promote the best care for people nearing the end of life.

People's needs were assessed and care was delivered in line with their care plan. .

The support we observed was delivered with kindness and respect. People told us that they were happy living at the home and we saw good interactions between the staff and people who live there. One person told us, ''It's very nice here, I would not want to go anywhere else".

There was an effective complaints system. People who were able to tell us, said that they were sure that their comments and complaints would be listened to and acted on effectively.

Inspection carried out on 26 January 2012

During a routine inspection

A person living in the home told us “staff never argue or pressure you, everything is by choice”. The person opted in to activities as they chose. Another person said that they had felt continuously involved in how their care was planned. As a result they felt their health had steadily improved whilst they lived in the home. They spoke about using the home and garden as they chose. They chose when to get up and go to bed, and when and with whom to socialise. They said the home “lets you be yourself”.

Another person who lived in the home told us all people were given good information about planned events, entertainments and trips out, so they could make their own choice about what to join in. A visiting relative told us they felt the home “made up the gaps (their relative) had in their life when they lived independently”. They described staff as “fully supportive”. They saw that their relative often took up opportunities offered to engage in activities, including trips out in the home’s vehicle and walks in the grounds.

We asked people if they felt safe living in the home. One person said “couldn’t be better”, another said “living here has made all the difference”. A visiting relative told us they considered the home “definitely” safe; their relative was “given space to live (their) own life, but staff always know where they are and check often”.

A person who lived in the home told us they thought the manager struck a good balance between encouraging choice and independence, and ensuring essential tasks were carried out professionally. The person said there were occasional residents’ meetings, but “people aren’t always prepared to speak up”. The person said the manager and deputy manager were always available and welcomed people’s comments and ideas. Another person who lived in the home told us the manager and deputy manager were “approachable and available, they listen and act on comments”. A visitor told us they saw staff constantly observing, and asking people in the home if they had all they wanted and needed.

Reports under our old system of regulation (including those from before CQC was created)