This was an unannounced inspection carried out on 19 January 2017.

Manor Gate Care Home can provide accommodation and personal care for 18 older people and people who live with dementia. There were 17 people living in the service at the time of our inspection.

The service was operated by a partnership that was the registered provider. 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. In this report when we speak about both the partnership and the registered manager we refer to them as being, ‘the registered persons’.

At our inspection on 23 December 2015 there was one breach of legal requirements. We found that the registered persons had not fully protected people who lived in the service against the risks of inappropriate or unsafe care by regularly assessing and monitoring the quality of the care and facilities provided. This was because quality checks had not been consistently effective in quickly resolving problems in the running of the service. These problems included there not always being enough staff on duty, shortfalls in the way new staff were recruited and oversights in the support people received to eat enough in order to stay well. In addition, the registered persons had not always ensured that care was provided in a way that fully respected people’s legal rights.

After the inspection the registered persons wrote to us to say what actions they intended to take to address the problems in question. We completed a further inspection of the service on 20 May 2016 when we found that the necessary improvements had been made to address the breach and to meet legal requirements.

At this inspection we found that staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. People had been protected from the risk of avoidable accidents and there were enough staff on duty. Background checks had been completed before new staff were appointed.

Parts of the accommodation were not adapted, designed and decorated to meet people’s needs and expectations. Staff had been provided with support and guidance and they knew how to support people in the right way. People had been helped to eat and drink enough to stay well and they enjoyed their meals. Staff had supported them to obtain all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered manager had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people's right to privacy, and promoted their dignity. Confidential information was kept private.

People had been consulted about the care they wanted to receive and had been given all of the practical assistance they needed. Staff promoted positive outcomes for people who lived with dementia. People’s choices were respected and they were offered the opportunity to pursue their hobbies and interests. There was a system for resolving complaints.

People had been invited to suggest improvements to their home and quality checks had been completed. The service was run in an open and inclusive way and good team work was promoted. Staff were

We carried out an unannounced comprehensive inspection of this service on 23 December 2015 when we found that there was a breach of legal requirements. This was because the registered persons had not fully protected people who lived in the service against the risks of inappropriate or unsafe care by regularly assessing and monitoring the quality of the care and facilities provided.

After our inspection the registered persons wrote to us to say what they would do to meet legal requirements in relation to the breach. They said that new and more robust quality checks had been introduced to ensure that people reliably received all of the assistance they needed.

We completed the present inspection on 20 May 2016 to check that the registered persons had completed their plan, to confirm that they now met the legal requirements and to check that people were safely receiving all of the care they needed. During this inspection we found the registered persons had made improvements in the specific areas we had identified and had met the legal requirements in the breach.

This report only covers our findings in relation to the breach. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Dr Bijoy Sinha & Dr Madhulika Sinha on our website at www.cqc.org.uk

Manor Gate Care Home is registered to provide accommodation and personal care for up to 15 older people some of whom live with dementia. There were 15 people living in the service at the time of this inspection.

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.

The registered persons had completed suitable quality checks to ensure that people reliably benefited from having the care and facilities they needed.

This was an unannounced inspection carried out on 23 December 2015.

Manor Gate Care Home can provide accommodation for up to 15 older people who need personal care. There were 13 people living in the service at the time of our inspection.

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.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach referred to the way in which quality checks had been completed. They were not rigorous or effective and this had resulted in a number of shortfalls not being quickly identified and resolved. The breach had increased the risk that people would not always safely and responsively receive all of the care they needed. You can see what action we told the registered persons to take in relation to the breach of the regulations at the end of the full version of this report.

The arrangements used to ensure that there were always enough staff on duty were not robust and some parts of the recruitment and selection procedure were not rigorous. Staff knew how to report any concerns so that people were kept safe from abuse. People had been helped to avoid having accidents.

Staff had not received all of the training and support the registered persons said they needed. However, staff knew how to provide people with the practical assistance they needed and wanted to receive. Although people had not been reliably helped to check their body weight, staff had supported people to have enough nutrition and hydration. In addition, staff recognised when people were unwell and had arranged for them to receive the necessary healthcare services.

The registered persons and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people where they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had not taken all of the necessary steps to ensure that people’s rights were protected. We recommend that the registered persons explore the relevant guidance on how to correctly follow all of the legal safeguards in the MCA and in the DoLs in order to ensure that people receive care that respects their legal rights.

People were treated with kindness and compassion. People’s right to privacy was respected and confidential information was kept private.

The registered persons and staff had promoted positive outcomes for people who lived with dementia and who could become distressed. People had been consulted about the care they wanted to receive and they had been supported to pursue their hobbies and interests. Staff had supported people to express their individuality and there was a system for resolving complaints.

The arrangements for obtaining feedback to guide the development of the service were not robust. People had not fully benefited from staff receiving and acting upon good practice guidance. However, steps had been taken to promote good team work and staff had been encouraged to speak out if they had any concerns.

The summary is based on our observations during the inspection, speaking with seven people who used the service, two relatives, the manager and four staff. In addition, we looked at care records, the arrangements to keep people safe from abuse, the systems used to maintain good standards of hygiene, staffing and quality assurance.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be kind and to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

Is the service responsive?

We found that the service was responsive. This was because people's individual needs for care had been assessed and met. Staff knew about each person’s care needs, choices and preferred routines. People said that their care needs were met in a flexible way with staff being happy to adjust the assistance they provided according to the person’s changing needs and wishes.

However, we have said that the provider may find it useful to make an improvement to further develop the service. This involved strengthening the way in which staff ensured that people maintained a healthy body weight.

Is the service safe?

We found that the service was safe. This was because staff understood their roles and responsibilities to ensure that people were protected from the risk of abuse including physical and financial abuse. The provider had made some arrangements to protect people against the use of unlawful or excessive control or restraint. This provision included having policies and procedures to guide staff in the correct application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The safeguards are designed to protect people when they need to have their liberty restricted.

Is the service effective?

We found that the service was effective. This was because people were helped to stay safe by avoiding risks to their health and safety. There were safe working practices to help people with reduced mobility. This reduced the likelihood of people experiencing falls and accidents. Most parts of the building were clean, equipment was in a hygienic condition and people’s bed linen and clothing was freshly laundered.

However, we have said that the provider may find it useful to make an improvement to further develop the service. This involved ensuring that the sluice could be thoroughly cleaned so that the risk of cross infection was minimised.

Is the service well led?

We found that the service was well led. This was because people had been consulted about their experience of using the service. There was a clear line of management. This meant that important decisions about organising someone’s care were made by senior staff while carers could use their own judgement to provide a flexible service.

However, we have said that the provider may find it useful to make some improvements to further develop the service. These involved ensuring that all quality checks were correctly completed and recorded. In addition, we said that new checks needed to be made of the accommodation so that defects could be quickly repaired.

We spoke with people who told us care staff discussed their care and treatment with them. One person who had recently moved into the home said, “They knew all about me. I have a care plan, I’ve certainly got one, but I don’t know it in too much detail.”

We spoke with visiting relatives and friends. One relative said, “I visit about five times a week. The food is ok sometimes, but I come to their dos.” Another relative said, “It is a nice family run home. I’m particularly impressed with the activities board.”

We saw most people had a commode in their bedroom. This meant people did not share the commode with others. However we saw most commodes had not been dried after being emptied.

We found people were not offered the choice to wash their hands before lunch. We observed lunchtime. We saw a member of staff stretched across a dining table and their shoulder length hair went into a person’ lunch.

We saw staff had the opportunity to achieve a nationally recognised training qualifications in health in social care.

Since our last inspection the manager had introduced processes to monitor and review the quality of service people received. The manager told us they had partly developed an index of policies, procedures to maintain the smooth running of the service.

We saw a copy of the weekly maintenance check list. Areas covered included fire alarm testing, gas supplies and hoist safety.

At our last inspection on 10 October 2012, we issued a compliance action because we identified a number of concerns. We have now visited the home and checked up on progress made. There was some improvements found but not all actions identified had been addressed.

We found some improvements to the garden area had been made and there was a plan in place for future refurbishment.

We had previously found some evidence of quality assurance monitoring but at this inspection we found no evidence of a systematic quality assurance system in place.

At a previous inspection we found people were not able to lock their bedroom doors if they wished to do so. At this inspection we found people were still not able to lock their doors. One person who lived at the home told us, “I would really like to lock my door. They did mention it once but nothing has happened.”

We had previously raised concerns about the use of the first floor bathroom as a sluice. On this visit we found the room was not locked, the toilet was heavily stained, and there was no assessment of risk for the room being used as a sluice.

At our last inspection the manager told us they intended to undertake staff appraisals by the end of July 2012. At this inspection we could not see any formal documentation of staff supervisions or appraisals.

At our last inspection of Manor Gate in May 2012 we issued seven compliance actions. We conducted a follow up visit on 10 October 2012. We found there were still outstanding actions regarding quality assurance and monitoring and audit processes.

As part of our visit we spoke with several people who lived at the home, some visiting relatives, members of staff and the manager.

The people we spoke with told us staff were kind to them and they were well cared for. They said they felt safe and would talk with staff if they had any problems.

Staff told us that training had improved and they had a clearer understanding of their roles and responsibilities. Most staff had received supervision since our last visit.

We looked at care records and saw people’s likes and dislikes were recorded and they were person centred.

There were no effective systems in place to regularly assess and monitor the quality of service that people received. The manager told us there were no environmental audits or health and safety assessments in place and no risk assessments regarding the safety of the building or the grounds.

As part of our inspection we spoke with several people who use the service and their relatives, care staff and the home manager. On the day of the visit there were eight people living in Manor Gate. Many of the people had communication difficulties.

We conducted a Short Observational Framework for Inspection (SOFI 2). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw people sat staring into space. There was no stimulation and staff were busy with other duties.

We spoke with people about what it was like to live at Manor Gate. People spoke positively about the care and support they received. They told us they felt safe living in the home. They told us staff listened to them and that staff and the manager were approachable if they needed to talk to them.

Some people told us they would like more activities. They said they enjoyed the sing along they had with the organist who visited every fortnight. We asked the manager and care staff what other activities were available for people. They told us there was no plan of activities but that care staff had a chat or a laugh with people when they had time.

We looked at all areas of the home and found the standards of cleanliness in some areas were poor. Staff training records showed no infection control training had taken place..

We observed staffing levels were not sufficient to meet people’s needs. Care staff’s time was taken up with non-care duties. They told us they were responsible for the laundry, preparing breakfast and tea and cleaning duties.