This was an unannounced inspection carried out on 22 January 2019. Caldy Manor provides personal care and accommodation for up to 38 older people.

Caldy Manor is a listed building set in its own gardens in Caldy Woods just off the main road through Caldy Village. The home is decorated to a good standard throughout with accommodation provided across four floors. A passenger lift enables access to bedrooms located on the upper floors. All bedrooms are single occupancy with en-suite facilities. Specialised bathing facilities are also available. On the ground floor, there is a communal lounge and dining room with access to a garden and patio area. The lower ground floor of the home is called 'Memory Lane' and is reserved for people who require more support from staff with daily living activities.

There was no registered manager in post, as the manager had left a few weeks before the inspection. The home were actively recruiting for a new manger. 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.' A deputy manager was acting as home manager at the time of the inspection and participated fully in the inspection visit.

At the last inspection in July 2016 the service was rated overall as good, and in each of the key questions: is the service effective, caring, responsive and well-led. The key question safe was rated as requires improvement.

At this inspection, we found improvements had been made following the last inspection. We rated the key question: is the service responsive as outstanding. We rated the key questions: is the service safe, effective, caring and well led as good. The service overall, has remained good.

The management of medicines had been improved since the last inspection and we found medicines were safely managed and robust checks were in place to identify and take actions when shortfalls were identified.

The provider ensured people had access to a wide range of meaningful activities. This included trips out to places that people said they wanted to visit and parties and events. We saw many examples of where the involvement of the local community had enabled people to feel included and part of their community once again. People told us they looked forward to things and felt excited by activities, visits and events at the service. This demonstrated activities were truly meaningful for people.

People and their relatives gave consistent, positive feedback about the service. This included the approach of staff, the food, the events that took place in the home and the accommodation.

People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.

People had access to sufficient quantities of nutritious food and drink. People's special dietary needs were catered for and people's preferences were noted and acted upon. Everyone we spoke with said the food was “excellent”. We observed the serving of lunch. The food looked and smelled appetising and was served pleasantly by staff.

Staff were recruited robustly and safely. They received training which ensured they were up to date with the skills required for their roles. New staff received an in-depth induction to the service which included the support of more experienced staff.

Risk assessments and risk management plans were in place. Personal care was delivered in line with assessed needs and accurate monitoring records were maintained.

We looked at how accidents and incidents were managed and found that they were recorded and reported appropriately. We saw that appropriate actions were taken following incidents, such as contacting the GP, emerge

This was an unannounced inspection carried out on 12 and 13 July 2016. Caldy Manor provides personal care and accommodation for up to 38 older people. Nursing care is not provided.

Caldy Manor is a listed building set in its own gardens in Caldy Woods just off the main road through Caldy Village. The home is decorated to a good standard throughout with accommodation provided across four floors. A passenger lift enables access to bedrooms located on the upper floors. All bedrooms are single occupancy with en-suite facilities. Specialised bathing facilities are also available. On the ground floor, there is a communal lounge and dining room with access to a pleasant outside garden and patio area. The lower ground floor of the home is called ‘Memory Lane’ and is reserved for people who require more support from staff with daily living activities.

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.’ On the day of our visit, the registered manager had only been in post approximately six months but they participated fully in the inspection visit.

We reviewed three care records and saw that care plans gave staff clear person centred guidance on how to meet people’s needs safely in accordance with the person’s wishes. The majority of people’s risks were assessed and well managed and we saw that people received care from a range of other health and social professionals. For example, doctors, dentists, district nurses and chiropody services.

People who lived at the home said they were happy the support they received. They told us staff looked after them well and treated them kindly. Everyone held the staff in high regard and felt they had the skills and abilities to meet their needs. During our visit, we saw that staff supported people with patience and compassion whilst at the same time gently encouraging them to be as independent as possible. From our observations it was clear that staff knew people well and genuinely cared for the people they looked after. Support was person centred, warm and positive.

People we spoke with told us that they were able to choose how they lived their life at the home for example, what time they chose to get up / go to bed, and what they wanted to do during the day. A good range of activities were provided to interest people and we saw staff simply took the time to sit and chat to people socially in addition to meeting their support needs. This promoted their well-being.

We saw that some of the people who lived at the home, lived with mental health conditions that impacted on their ability to make decisions. Where people needed to be deprived of their liberty to protect them from harm, mental capacity assessments and deprivation of liberty safeguard applications had been submitted to the Local Authority in accordance with the Mental Capacity Act 2005. This ensured legal consent was obtained. Further work was required to ensure that these elements of good practice were routinely applied to other specific decisions about people’s care. It was clear however from people’s care records and our observations of people’s care, that gaining people’s consent to their care was important to the manager and the staff team.

People had access to sufficient quantities of nutritious food and drink. People’s special dietary needs were catered for and people’s preferences were noted and acted upon. The majority of people we spoke with said the food was good. We observed the serving of lunch. The food looked and smelled appetising and was served pleasantly by staff.

We observed a medication round and saw that medicines were administered safely. The majority of me

People’s care needs were written in detail in their care plans and these were kept up to date with regular reviews. People we spoke with were satisfied with the care that they received. One person told us “We get very well looked after here”. A visitor told us “I am more than happy with the care and attention my relative receives here”.

People received a choice of nutritious meals and appropriate action was taken to identify and address any concerns about nutrition.

People’s medicines were well managed to ensure that they always received their medication as prescribed by their doctor.

Employment checks were carried out to ensure that new staff were safe and suitable to work with frail older people. All staff received annual training about safeguarding vulnerable people from abuse. A visitor told us “The staff are great, they are so kind and caring”.

We spoke with three people who were living at Caldy Manor and they considered that they were treated with respect by the staff and were able to choose how they spent their time. They described the staff as “wonderful” and “so patient”. Care plans that we looked at gave information about people’s personal preferences, for example what time they liked to get up in the morning and go to bed at night. People were able to express their views at residents’ meetings and we saw that people who lived at the home and their relatives had been involved in reviewing their care plans. The home had a full-time activities organiser who provided social events in the morning and afternoon, and also spent time with people who preferred to stay in their own room. There was a good choice of dishes at every meal time.

People living at Caldy Manor did not require 24 hour nursing care and people who had nursing needs received a service from district nurses. People had regular visits from their GP and from other health professionals as needed including dietician, memory nurse and continence advisor. A chiropodist visited the home regularly.

The home provided a high standard of accommodation which appeared to be well-maintained throughout. The maintenance person kept detailed records of all equipment and safety checks.

There were enough qualified, skilled and experienced staff to meet people’s needs.

In a recent satisfaction survey and the following comments were made:

The staff are all very pleasant and my relative is extremely happy in her new environment.

Social activities are exceptionally good, inclusive and appropriate.

The staff are always very helpful and respectful towards residents and visitors.

I used to be a GP working in this area and I chose this care home for my parents because of the high standards I had seen there during my professional visits.

I am very happy with the level of care the nursing staff provide.

The expert by experience spoke with people who live at the home and visiting relatives. One relative told the expert that she was very satisfied with her mother’s care. She said “everything is brilliant, the staff are lovely and friendly. Mother has a buzzer at the side of her bed but she doesn’t use it, she does join in some of the activities upstairs”. The people who the expert spoke with in the lounge were “very sure that they were happy” and there was a calm, relaxing atmosphere. They confirmed that they could get up when they wished and a cooked breakfast is available; they could go to bed when they wished with a hot drink of their choice and toast or a sandwich.

One person who had been confined to bed for a couple of days with a bad cold told the expert that “the carers were very good to me”.

The expert considered that portions served at lunchtime were rather small, however none of the people she spoke with had any complaints about the food and they said it was “very good”, ”food quite good”, “I can have an alternative if I don’t like what is offered”. A Jewish lady said that her dietary needs were catered for.

A visitor who spoke with the expert said he was concerned that his mother had lost weight. He considered that she was receiving more support with her meals since she moved to live on the dementia care unit.

A relative who spoke with the expert by experience told her that he had raised two concerns and these were resolved quickly to his satisfaction.