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Manor House Residential Home Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 5 February 2020

About the service

Manor House Residential Home is a residential care home for up to 22 older people living with dementia. At the time of inspection there were 21 people living at the home.

People’s experience of using this service and what we found

There was a registered manager who had been the manager of the service since it registered with CQC in October 2010.

The provider did not have adequate systems in place to assess and monitor the safety and quality of people’s care. Their policies were outdated and did not reflect current practice. The provider had not carried out regular audits to maintain the safety of the environment, fire safety procedures, decoration or repairs. Immediately following the inspection, the provider implemented systems to monitor and improve the safety of the home; these systems needed to be shared with staff and embedded into practice.

Staff did not always understand how to safeguard people from the risk of harm. Following the inspection, the provider updated their policy and put in systems to identify when incidents occurred and when to report to safeguarding. These systems require embedding to be effective.

Staff were recruited using safe recruitment practices, however, the provider did not have systems in place to ensure staff remained safe to work.

There were enough staff deployed to meet people’s needs. People’s medicines were managed in a safe way. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care that mitigated these known risks. People were supported to access relevant health and social care professionals.

People received care from staff they knew. Staff had a good understanding of people's needs, choices and preferences. People and their representatives were encouraged to be involved in planning how their care was provided. Staff gained people's consent before providing personal care and ensured their privacy and dignity were maintained.

Staff received training to enable them to meet people’s needs and were supported to carry out their roles.

There was a complaints system in place and people were confident that any complaints would be responded to appropriately.

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

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was Good (published 22 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.


We identified three breaches of regulation in relation to safety of the environment; safeguarding and management oversight. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection areas


Requires improvement

Updated 5 February 2020

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 5 February 2020

The service was not always effective.

Details are in our effective findings below.



Updated 5 February 2020

The service was caring.

Details are in our caring findings below.



Updated 5 February 2020

The service was responsive.

Details are in our responsive findings below.


Requires improvement

Updated 5 February 2020

The service was not always well-led.

Details are in our well-led findings below.