Mancroft is a ‘care 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 and both were looked at during this inspection. Mancroft is a care home without nursing, which can accommodate up to five people. There is also a supported living premises which accommodates up to two people. At the time of our inspection five people were using the care home service and two were using the supported living. These included people with learning disabilities or those on the autistic spectrum, people with mental health difficulties, or younger adults.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The inspection visit took place on 07 November 2018 and was unannounced.

There was a registered manager in post who was there at the time of the inspection. 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 continued to receive care that made them feel safe and staff understood how to protect people from abuse and harm. Risks to people were assessed and guidance about how to manage these was available for staff to refer to/follow. Safe recruitment of staff was carried out and adequate numbers of staff were available to people. People received medicines as required.

People continued to receive effective support from staff with a sufficient level of skills and knowledge to meet their specific needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People were assisted to access appropriate healthcare support and received an adequate diet and hydration.

The care people received was provided with kindness, compassion and dignity. People were supported to express their views and be involved as much as possible in making decisions. Staff supported people to have choices and independence, wherever possible. People’s diverse needs were recognised and staff enabled people to access activities should they so wish.

The provider had effective systems in place to regularly review people’s care provision, with their involvement. People’s care was personalised and care plans contained information about the person, their needs, choices and cultural needs. Care staff knew people’s needs and respected them. People were able to speak openly with staff and understood how to make a complaint.

The service continued to be well-led, including making detailed checks and monitoring of the quality of the service. People and staff were positive about the leadership skills of the registered manager. We were provided with information we expected to receive.

Our inspection was unannounced and took place on 10 May 2016.

At our last inspection of 6 May 2014 the provider was meeting all of the regulations that we assessed.

The provider is registered to accommodate and deliver personal care to a maximum of five people who had a learning disability or an associated need. On the day of our inspection five people lived there.

The manager was registered with us and was present during our inspection as was the provider. 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.

We saw that there were systems in place to keep people safe and to protect them from the risk of abuse. People had not experienced anything that hurt them or that they were afraid of.

Staffing was provided in sufficient numbers to meet people’s needs and preferred routines.

Medicines were managed safely to ensure that people were supported to take them as they had been prescribed.

The provider had systems in place to recruit new staff. Staff received an induction which gave them the initial knowledge and support they required to meet people’s needs. Staff numbers and experience ensured that people would be safe and their needs were met in the way that they wanted them to be.

Staff had training and one to one supervision to equip them with the knowledge they needed to provide appropriate support to the people who lived there. Staff felt that they understood their job role and responsibilities.

Staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that the provider was meeting the requirements set out in the MCA and DoLS to ensure that people received care in line with their best interests and were not unlawfully restricted.

People felt that the staff were nice and kind and we saw that they were. Interactions between staff and the people who lived there were positive, staff were polite and helpful to people.

People liked the food and drink that they were offered. Records confirmed that the people who lived there were supported to have a varied diet to promote good health.

People were supported to access to health care services to promote good health.

An easy read complaints system was available so that people and their relatives could state any concerns and dissatisfaction if they had the need.

The provider used feedback forms to get the views of people, their relatives and external healthcare professionals on the service provided.

Feedback from people, relatives and staff was that the service was well-led. We saw that the provider had monitoring and auditing systems in place to ensure that the service met people’s individual needs and preferences.

Below is a summary of what we found at this inspection. The summary is based on our observations during the inspection, spending time and talking with four people using the service, two staff that supported people, the manager, and provider. We saw three recent survey forms that were returned to the home recently with comments from two relatives and a visiting professional. We looked at two people’s care records as well as other records related to the running of the service.

We previously completed an inspection in December 2013, where we found the provider was not compliant with regulations and some improvements were needed. After the inspection, the provider sent us an action plan. This told us the action the provider would take and by what date.

At this inspection we checked whether required improvements had been made to meet compliance actions identified at the last inspection. We completed a scheduled inspection and looked at other essential standards of care. We found the provider had made the required improvements and was compliant with regulations.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People are treated with respect, they were offered choice and their consent was sought by staff before they provided care or support. People we spoke with told us they were happy living at the home. A relative said, “Excellent, my (relative) is looked after with the best of care, for me this is a worry lifted”. Staff knew about people’s risk management plans and we saw that they supported people in line with these. For example staff understood how to ensure people were given their medication in a safe way. This should mean that the safety of people that use the service is promoted.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do. No DoLS applications had needed to be submitted. The manager and provider understood when an application should be made, and how to submit one. This means that people will be safeguarded as required.

We saw that there was sufficient staff to ensure people’s care needs were taken into account, and that staff were supported so that they had the qualifications, skills, experience and support they required. This helps to ensure that people’s needs are always met.

Is the service effective?

People’s health and care needs were assessed with them, and other professionals contributed towards information in their plans of care. Specialist needs had been identified in care plans where required. We saw that care plans reflected assessments and observations that staff carried out and recorded; this relating to people’s day to day needs and preferences.

People’s needs were taken into account with the layout of the service enabling people to move around freely and safely. We saw that people were consulted about the care and support they received and a relative said, “Always informed excellent communication”. A visiting professional said, “No concerns about the level of support provided”.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People looked comfortable in the presence of staff and we saw that they were comfortable approaching them. We saw staff responded readily to any verbal or non-verbal request for assistance from people.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People we spoke with told us about the activities they participated in and how they enjoyed these. One person told us how they were supported to observe their religion.

Is the service responsive?

People completed activities in and outside the service regularly. The home was sited close to a number of local amenities and has its own transport, which helps to keep people involved with their local community. One person also told us they were happy living at the home as the best thing was, “Church around the corner, shops up the village and greengrocers”.

People and relatives were aware of the service’s complaints procedure and knew how to raise concerns. One relative said, “Never had to use it, but if I did I am confident that it would be dealt with professionally”.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service has a quality assurance system; records seen by us showed that identified shortfalls were addressed promptly. The overview of the service’s audits could be more robust, but the manager and provider were easily able to show us how they checked the quality of the service, and identified when and where there may be areas that needed improvement. This helped to ensure that people received a good quality service at all times.

Our inspection was announced. We gave short notice of our inspection as we knew that the people that lived there had active lives and were out of the home frequently and we wanted the opportunity to meet with them.

Four people lived at the home on the day of our inspection. We spoke or spent a short time with all four people. We also spoke with two of their relatives by telephone. We spoke with four staff, the registered manager and the registered provider. All people and their relatives that we spoke with were complimentary about the home in general, the care and support provided and the staff. One person said, “I like it very much. The staff look after me well”. Another person told us that they were happy and liked the staff that looked after them. One relative told us, “As soon as I walked into the home I knew that my family member was going to be happy there and they are very happy”. Another relative said, “I wish they could have lived there years ago. They love living there. They have never been so happy. It is home from home”.

We saw that people were encouraged to do things for themselves, promoting their independence skills and self- esteem. One person said, “It is nice here. I can go out when I want to.” We saw that people were supported to have regular health checks of their physical and mental health to promote their good health and ensure their wellbeing. A relative told us, “The staff always promote independence and give people choices”. One person said, “I have been to see the doctor".

People had been provided with varied food and drink options to prevent malnutrition and dehydration. One person who lived there said, “I like the food. It is good”.

Recruitment processes were in place which gave the people that lived there and their relatives assurance that only suitable staff had been employed. This reduced the likelihood of people being subjected to harm or abuse. One person told us, "The staff are very kind."

We found a lack of assessments and systems to determine what staffing levels were required. We also found that at least two staff who worked alone providing care and support to people had not received mandatory training such as first aid. This meant that the registered provider did not have a framework in place to justify low staff numbers on some shifts or give assurance that staff could safely look after the people they supported.

We found that a complaints process was in place. This gave the people that lived there and their relative’s assurance that their complaints would be appropriately dealt with.

We visited 2 Mancroft Road on the 10 & 15 May 2012 to undertake a scheduled inspection. We looked at the information we had about the home prior to our visits.

We spoke with four people that lived at the home, three relatives, two staff, the manager and provider. We looked at two people’s care records, three staff files and other records associated with the operation of the home.

People who used the service were consulted about the care and support they received, and supported to have involvement in decisions by staff. People told us about activities they choose to be involved in, and we heard that people’s independence and confidence was promoted. A relative told us that the manager had “Given independence”. We saw staff respected people’s privacy, and relatives said that people are “Always offered privacy”.

People’s needs were assessed with care and support planned and delivered in line with their individual care needs.

People told us they were happy living at Mancroft Road and they received the support they wanted from staff. Relatives told us that “Care that getting is absolutely brilliant”, “Couldn’t wish for anything better” and that people “loved it there”. Health professionals that the home surveyed had responded by saying “It’s a pleasure working with at moment”, and “One of the better services to deal with”.

People who used 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. There was information available so that people knew who to contact if they felt unsafe. People we spoke with said they had no concerns about their safety.

The provider had taken steps to provide care in an environment that is suitably designed and well maintained, providing a ‘homely’ environment for people living there. We saw Mancroft Road blends in with the surrounding properties, and presented as a family home, this fitting the provider’s objective to “provide an environment that is warm, welcoming and well maintained”.

People were supported by suitably qualified and experienced staff. We saw staff spending time with people and the relationships we observed presented as positive. People looked relaxed in the presence of staff. Relatives told us that they were satisfied with the staff one saying that had “Peace of mind and confidence in staff”. A Visiting professional stated in the homes survey forms that staff “Are very helpful” and “team acts as one”.

Staff told us that the provider and manager had very high standards and “inspired” staff to maintain these. We heard from staff that the provider was receptive to ideas, but had not accepted lower standards.