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Inspection carried out on 29 August 2017

During a routine inspection

This inspection took place on 29 and 30 August and 13 September 2017 and was unannounced. Manor Farm is a care home which provides nursing and residential care for up to 81 older people. At the time of this inspection there were 74 people using the service. The home is divided into three units spread across three floors, all accessible by lift. The top floor of the home is for people requiring residential care, the middle floor is for people with dementia and the ground floor is for people with nursing needs.

At the last inspection in May and June 2015, the service was rated Good overall but had one breach of the regulations because the provider had not had a registered manager for more than twelve months. 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. At this inspection we found this issue had been rectified. There was a registered manager in post.

People and relatives thought the service was safe. Staff were knowledgeable about how to report concerns or abuse. The provider had a recruitment system in place to ensure the suitability of staff working at the service and there were enough staff on duty to meet people’s needs. Risk assessments were carried out with management plans in place to enable people to receive safe care. The provider was in the process of carrying out refurbishment of the premises. There were systems in place to maintain the cleanliness and safety of the premises. The provider had systems in place to ensure the safe administration of medicines.

Staff received appropriate support through supervisions and training opportunities. Appropriate applications for Deprivation of Liberty Safeguards (DoLS) had been applied for and authorised. Staff were aware of the need to obtain consent before delivering care.

People were offered varied and nutritious menus of food, snacks and drinks. People also had access to healthcare professionals as required to meet their day to day health needs.

People and relatives thought staff were caring. Staff were knowledgeable about how to develop caring relationships with people who used the service. People’s privacy and dignity was respected. Staff had awareness of The Equality Act 2010 and delivering care in a non-discriminatory way. People were given choices and their independence was encouraged.

Staff were knowledgeable about providing a personalised care service. Care plans were detailed and showed people’s preferences. A variety of activities were offered which included trips outside the home and visiting entertainers. People and relatives knew how to complain and the provider dealt with complaints in accordance with their policy. The provider kept a record of compliments about the service.

People, relatives and staff spoke positively about the management of the home. Regular meetings were held for people who used the service and relatives to check they were happy with the service provided. The provider had held a themed day to obtain feedback about the service. The service was asked to provide dementia training to the local community. Staff had regular meetings to keep them updated on policy changes, service development and to encourage good working practices. The provider had quality assurance systems in place to identify areas for improvement.

We have made two recommendations around the storage of medicines and supporting people with specific health conditions. Further information around this can be found in the detailed findings.

Inspection carried out on 28, 29 May, 3, 4, 5 June 2015

During a routine inspection

Manor Farm is a residential and nursing home which provides nursing and personal care for up to 81 older people. At the time of this inspection there were 54 people using the service. The top floor of the home is for people requiring residential care, the middle floor is for people with dementia and the ground floor is for people with nursing needs.

We last inspected the home on 15, 16 and 17 September 2014. During this inspection we found breaches of three regulations. The provider had not ensured that there was enough equipment to promote the comfort, independence and safety of people using the service. There was also not enough qualified, skilled and experienced staff to meet people’s needs. The provider did not have an effective system in place to monitor call-bell response times, the performance of staff working at weekends or during the night and we saw no evidence that the provider carried out their own monitoring checks of the service.

We carried out this unannounced inspection on 28, 29 May, 3, 4 and 5 June 2015.

During the inspection we found people consistently received their medicines safely and as prescribed. There were systems to check and maintain the safety and suitability of equipment and the premises and these checks were up-to-date. Staff were knowledgeable about the procedures relating to safeguarding and whistleblowing. Safe recruitment checks were carried out and there were adequate numbers of staff to meet people’s needs.

Some people thought staff were caring and things had improved since the current manager took up their post. Staff respected people’s privacy and dignity and enabled people to maintain their independence.

Staff received regular opportunities for training. The manager was aware of their responsibilities around legislation regarding people’s mental capacity. Staff were knowledgeable about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. MCA is legislation protecting people who are unable to make decisions for themselves and DoLS apply to people where the state has decided their liberty could be deprived in their own best interests to ensure their safety and welfare.

People had a choice of nutritional food and drink and were able to make choices from the menu or ask for alternatives. Staff were aware of people’s dietary requirements. People had access to healthcare professionals as required to meet their day-to-day health needs.

We saw there were group and individual activities on offer to ensure people had their social and emotional needs met. These included activities outside the home. People’s care plans were person-centred and staff were aware of people’s individual needs and preferences. Staff felt able to raise concerns with the managers. People knew how to make a complaint and these were dealt with appropriately.

At the time of our inspection there was no registered manager at this home. 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 previous registered manager had left employment in April 2013. Since this date there have been three managers in post who did not become registered. A new manager was due to start employment in June 2015.

The provider had systems in place to monitor the quality of care and support in the home and to obtain feedback from people using the service and their representatives. Staff told us they felt supported and had regular supervision and appraisals.

Inspection carried out on 15, 16, 17 September 2014

During an inspection in response to concerns

We considered our inspection findings to answer questions we always ask:

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found:

Is the service safe?

Staff we spoke with were able to demonstrate to us the actions they would take in the event of an emergency. For example, one staff member gave an example of an emergency situation they had recently dealt with and told us they �made sure [person] was breathing, talked to [person], made sure hazards were out of the way, called the senior and called the ambulance.� We reviewed the staff training matrix and saw staff were up to date with first aid training.

Is the service effective?

People had their needs assessed before they entered the service. Staff we spoke with demonstrated their understanding of what people�s care needs were. We saw people were given choices of food and drink and those that needed assistance to eat or drink were given support at their own pace. We saw there were bowls of fruit on offer but two staff members told us there were times when there was not enough fruit for people. Staff and family members told us there was not enough staff to meet people�s needs and we were told, �if there was more staff� this would make it better.

Is the service caring?

People and their family members who we spoke with told us that staff were caring. For example, one person told us, �the staff are good with everything about me" and "they help me and say don�t give up.� We observed that staff asked people how they wanted to receive their care. We noted from a quality assurance survey, one family member had written, �all of the staff are very caring.�

Is the service responsive?

We saw there were systems in place to obtain the views of people who use the service and their representatives. For example, a meeting for family members had been held in July 2014 and one of the outcomes of this was the staffing levels were increased by one staff member in the mornings on two of the floors. However, we found there was not enough hoisting equipment to meet people�s needs. We also found there was a backlog to the laundry due to inadequate laundry facilities.

Is the service well-led?

The service had a manager in post who was in the process of becoming registered and who was supported by a deputy manager to manage the home. We saw there were systems in place to monitor the quality of service. For example, we saw family members were sent a letter asking for their views about the service and there were regular residents meetings held to obtain the views of people using the service. However, we noted there was no system in place to monitor staff during the night or at weekends and there was also no system in place to monitor call-bell response times.

Inspection carried out on 13 September 2013

During an inspection in response to concerns

People we spoke with told us they felt they received good care which met their needs and requirements. One person we spoke with told us the care was "very good." another person told us they were "very happy here, no complaints." We found care and treatment was delivered in a way that protected people from harm and provided for their individual care needs.

People we spoke with told us they had enough food and drink to meet their needs. One person told us the food was "very good, very nice." Another person told us "On the whole, it (the food) is not bad." and "I can choose to eat plain food." We found people were protected from the risks of inadequate nutrition and dehydration because the provider had taken appropriate steps to provide people with nutritious food and drink.

People we spoke with told us they had enough equipment to meet their individual needs. One person told us "I have my chair and I can get about." We found there were sufficient supplies of equipment available to meet the needs of people who used the service.

There were enough qualified, skilled and experienced staff to meet people�s needs. People we spoke with told us they thought there were enough staff available to meet their needs. We found the service conducted a monthly dependency review sheet which assessed the number of residents and their dependency rating.

Inspection carried out on 2 May 2013

During a routine inspection

People we spoke with told us they were treated with respect and their privacy was maintained by staff. One relative we spoke with told us staff were "very respectful, they're doing a great job."

We found people�s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People we spoke with told us they received good care. One relative we spoke with told us "she used to fall a lot at home; but they are very caring."

People we spoke with told us "yes" when we asked if they felt safe. People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found appropriate arrangements were in place in relation to the recording of medicine. Staff we spoke with told us they recorded when they administered people's medication.

People we spoke with who used the service told us they had no complaints about the service. They also knew who they could speak to if they did. For example one relative told us "no complaints, you go to the head person."

Inspection carried out on 12 July 2012

During an inspection in response to concerns

People who used the service told us they enjoyed living at Manor Farm Care Home " everything is straight forward" and "it's not too bad here". One person told us they were "very happy here, no complaints".

People told us they had choice about how they dressed and how they lived in their rooms. One person told us "I have my things the way I like".

Inspection carried out on 16 February 2012

During an inspection looking at part of the service

During this inspection, people told us that they liked the staff, although they were very busy. People told us they liked the food provided in the home. People commented positively on standards of cleanliness.

Inspection carried out on 13 November 2010 and 23 January 2011

During a routine inspection

We visited Manor Farm Care Home over three days in November 2010. We talked to those people who were able and happy to talk to us. We also talked to relatives of some people who, because of their assessed needs, were not able to talk to us directly. We also spoke with some people who visit the home regularly.

We received a number of positive comments from people, and also some comments that recognised that the service still needed to achieve more improvements.

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