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Inspection carried out on 23 April 2019

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

About the service: At the time of the inspection The Manor House was a nursing home registered to provide personal and nursing care for up to 25 older people, there were 23 people living in the home. The provider contacted us after the inspection to advise that they would now be providing care to adults over the age of 18 years. An updated Statement of Purpose has been submitted to the Commission as required

People’s experience of using this service: People, staff and relatives spoke positively about the registered manager and told us they felt comfortable to report any concerns. The registered manager was visible in the home and undertook checks throughout each day to ensure the home ran smoothly. Staff, relatives and people were invited to express their views and opinions in different ways and told us that they felt listened to.

There was a positive, person-centred culture and staff worked as a team and with external organisations to ensure people experienced good outcomes.

Staff received safeguarding training and spoke confidently about how to identify potential abuse and actions they would take if abuse was suspected. There were posters and leaflets throughout the service including details about how to whistle blow and where to report safeguarding concerns.

People told us they felt safe and relatives confirmed this. Risks to peoples’ safety were assessed, monitored and actions were taken to ensure risks were managed. The service allocated staff in accordance with peoples’ individual needs and maintained staffing levels in accordance with their staffing dependency tool.

The service managed medicines safely and had processes in place to ensure that people received their medicines when they should.

The registered manager had identified areas for improvement, including the range of activities available for people and areas in the home that required some cosmetic updating, and was working to improve these areas at the time of our inspection.

Rating at last inspection: Good (Published in April 2018)

Why we inspected: This inspection was brought forward due to information of risk and concern; there were concerns that people may not be receiving the correct amount of fluids. We inspected the service against two of the key questions which were, ‘is the service safe?’ and ‘is the service well-led?’. None of the concerns were substantiated.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 27 February 2018

During a routine inspection

The Manor House is a nursing and residential care service providing support and accommodation for older people. The service is registered to accommodate a maximum of 25 people and at the time of the inspection 20 people were living in the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, we looked at both during this inspection.

The home has extensions built on either side of the main older building. The communal areas and several bedrooms are on the ground floor and because of the design of the building a few of the corridors are narrow. At the front of the building is a large car parking area and at the back is a patio area and a sloping garden. The building was currently going through a phase of planned redecoration and upgrading.

At the last inspection on the 12 and 13 November 2015 the service was rated as Good. At this inspection we found the service remained Good.

People were safe living at the home and with the staff supporting them. We saw people were happy and trusted the staff. There were systems and processes in place to minimise risks to people. These included recruiting the right staff and making sure they knew how to recognise and report abuse. We were told by some people, their relatives and some staff that there should be more staff. The provider was going to review staffing levels.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and understood the importance of safe administration of medicines.

People received effective care from staff who knew them well and had the skills and knowledge to meet their needs. Staff monitored people's health and well-being and made sure they had access to healthcare professionals according to their individual needs.

People were supported to have maximum choice over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring. People's privacy and dignity was promoted and respected. However staff did not always knock before entering people’s bedrooms.

The service was responsive to people's needs and choices about their daily routines and how they wanted to be supported by staff. People had access to a limited range of organised and informal activities. Relatives were welcomed in the home and their views and feedback were taken into account when planning care. Information about the service was available for in communal areas for people and visitors to read.

People we spoke with told us they were happy and had no complaints. Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The registered manager and provider treated complaints as an opportunity to learn and improve. There were also regular, complimentary comments made about the service from relatives.

The home was well led by an experienced registered manager and the provider had systems in place to monitor the quality of the service, seek people's views and make on-going improvements.

Further information is in the detailed findings below.

Inspection carried out on 12 & 13 November 2015

During a routine inspection

This inspection took place on 12 and 13 November 2015 and was unannounced. The home provides accommodation, nursing and personal care for up to 25 older people, some of whom are living with dementia. There were 15 people living at the home when we visited.

There was a manager but they were not registered with the Care Quality Commission. The manager was new and told us they were in the process of registering with us. 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 and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people’s legal rights was followed correctly. People’s ability to make decisions had been recorded, in a way that showed the principles of the Mental Capacity Act 2005 (MCA) had been complied with. Staff were offering people choices and respecting their decisions. The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely. There was an environment maintenance and improvement program that gave consideration to ensure the environment supported people living with dementia or those with visual perception difficulties. The program had an action plan where improvements were required.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people and/or relatives were conducted regularly. Activities were offered with people able to choose to attend or not.

There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process was safe and helped ensure staff were suitable for their role. Staff received training to meet the needs of people and were supported.

People and relatives were able to complain or raise issues on a formal and informal basis with the manager or staff and were confident these would be resolved. This contributed to an open culture within the home.

Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The manager and provider were aware of key strengths and areas for development of the service and there were continuing plans for the improvement of the environment. Quality assurance systems were in place using audits and regular contact by the provider and manager with people, relatives, staff and other professionals.

Inspection carried out on 21 October 2013

During a routine inspection

People told us they were "very happy" and "nicely relaxed" living at this service. One person told us "all the staff here are so very kind". Another person said "they are always willing to help when things get a bit tough for me".

A visitor we spoke with was happy with the care their relative received. They told us “this is definitely a lovely home and I’m so glad mum’s here”.

During our visit, we saw that the service had policies and procedures in place that kept people safe. Staff were knowledgeable and confident about their safeguarding responsibilities and how they would respond to any concerns that may arise. People we met told us they felt safe.

We saw five people taking part in an activities session. We saw staff engaged with each person positively and observed how much people were enjoying themselves.

The manager showed us how people's opinions were obtained through surveys, and we saw there were robust processes in place to monitor the quality of service being provided.

Inspection carried out on 1 February 2013

During a routine inspection

At the time of our inspection there were 20 people who lived in the home. During our inspection we spoke with four people who lived in the home, four relatives, two nurses and two care assistants. We also read four people’s care plans to understand how staff planned, assessed and delivered care to people in the home.

Throughout our inspection we saw people were comfortable and relaxed in the home. People we spoke with told us “staff are marvellous, they get you what you need”. Another person said when we asked if staff respected their privacy and dignity, “staff put the screen up in the lounge when they need to move you” and they “knock on your door before they enter your room”. One person said “sometimes I can’t understand staff when they talk too fast”. The majority of visitors we spoke with were very happy with the care their relative received. One visitor said “It’s a very good home, probably the best one in Weston”.

We saw the manager provided opportunities for people to share their experiences of the care provided, so the standard of care could be improved. People had their care and treatment assessed so risks were identified and managed. If care was not meeting people’s needs effectively, the manager took actions to address this. This included regular team meetings to increase staff knowledge and competence.

Inspection carried out on 29 November 2011

During a routine inspection

When we visited Manor Park we asked people if they were treated with respect and received the care and support that they needed. We asked them about the meals and what it was like to live in the home.

People we met and spoke with during our visit said “everyone is very kind here”, “I can not fault the way I am looked after” and “I feel safe and cared for”. They told us “we all tend to have our preferred chairs in the lounge”, “if we don’t like the dinner we can ask for something else” and “the girls are always kind and polite. They are very kind to me”. They told us they were well looked after, they got all the help they needed, and “the staff have time for me”.

From our observation we found that people appeared to be relaxed and content in the company of the staff. There was a good rapport between the staff and the people who live in the home.

People told us “the meals are very nice”, “the staff know I don’t like certain foods so my meals might be different” and “I like to have my meals served in my room and the staff don’t seem to mind. They have a long walk to my room”.

One relative told us “I have seen the meals and they always look very nice and well presented”.

Staff told us “the meals are always good” and “the cook knows what people like and don’t like”.

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