The inspection took place on 17 and 21 January 2019 and was unannounced.

Manor House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 16 people in one adapted building. On the day of the inspection 14 people lived in the home.

The registered manager was also 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.

Records did not always reflect all the information we were told was sought during the recruitment process. People were supported safely with their medicines; however at the beginning of the inspection, some staff training was not up to date in line with the provider’s policy. Checks and audits completed by the registered manager had not always been recorded. We have recommended the registered manager reviews their governance procedures.

People told us they felt safe using the service. Risk assessments were in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

People received support from staff who knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. When people became anxious or low in mood, staff used their in-depth knowledge of people to ensure they received the right support.

People, relatives and staff told us the found the service to be ‘homely’. However, we have made a recommendation about the environment as it did not currently reflect best practice in dementia care.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Staff knew who lacked the capacity to make decisions and care plans gave information for staff to use when making decisions in people’s best interests.

People had enough to eat and drink and had choice about what they ate. Staff were very responsive to any change in needs or health concerns.

People were provided with activities to engage them in the home. Staff told us these were based on their knowledge of people’s interests. However, people were not routinely asked if they would like to access the local community. We have made a recommendation about this.

There was a positive culture within the service. The registered manager led by example and the standards they expected were known by the staff team. Staff clearly cared about the people they supported and worked to maintain people’s wellbeing. Staff understood how to communicate with people effectively and offered choice wherever possible.

People and relatives told us they they found the registered manager and staff approachable and any changes or concerns were dealt with swiftly and efficiently. People had regular opportunity to share their views of the service and any required changes were made promptly.

This inspection took place on 14 September 2016 and was unannounced. At the last inspection on 11 September 2015 we found that medicines were not managed safely. Documentation relating to medicine management was not being completed accurately. We asked the provider to take action to make improvements. You can see what action we told the provider to take at the back of the full version of the report. At this inspection we found that improvements had been made and practices were generally safe however, there were still some gaps in the recording of fridge temperatures for fridges used to store people’s medicines.

Manor House is a care home that provides care for people who have dementia or mental health needs. The home can accommodate up to 16 people. At the time of the inspection there were 16 people living at the service. The home was arranged over two floors, with access to the upper

floor via stairs or a chair lift. Bedrooms had wash hand basins and vanity units. There were shared bathrooms, shower facilities and toilets. Communal areas included two lounges, a dining room, a well maintained garden and an outside seating area.

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.

We observed positive, compassionate and caring interactions between people and staff. Staff took the time to stop and chat with people and to share appropriate humour. Staff knew the people they cared for well and spoke about them with fondness and affection. One staff member said; “The best thing is being with the residents, to see a smile on their faces means everything to me”.

People’s care plans were detailed documents which contained information about their background, history, likes and dislikes. People’s care plans were linked to risk assessments and contained information for staff on how to reduce the likelihood of them coming to harm.

People told us they enjoyed the meals. They told us they were of sufficient quality and quantity and there were alternatives on offer for people to choose from. People were involved in planning the menus and their feedback on the food was sought.

People had their healthcare needs met. For example, people had their medicines as prescribed and on time. People were supported to see a range of health and social care professionals including speech and language therapists, chiropodists, district nurses and doctors.

People were kept mentally and socially engaged through a range of activities inside the home. The service employed an activities coordinator who was developing a programme of personalised activities to suit people’s individual needs.

People were kept safe by suitable staffing levels. Relatives told us there were enough staff on duty and we observed unhurried interactions between people and staff. This meant that people’s needs were met in a timely manner. Recruitment practices were safe. Checks were carried out prior to staff commencing their employment to ensure they had the correct characteristics to work with vulnerable people.

Staff had received training relevant to their role and there was a system in place to remind them when it was due to be renewed or refreshed. Staff were supported in their role by an ongoing programme of supervision, appraisal and competency checks.

There was a safeguarding adult’s policy in place and staff had received training on this subject. Staff confidently described how they would recognise and report any signs of abuse. There was a policy in place on whistleblowing which staff were aware of and applied to their practice. The registered manager promoted an ethos of openness and honesty which demonstrated the requirements of the duty of cand

The inspection took place on 11 September 2015 and was unannounced.

Manor House provides care and accommodation for up to 16 older people who are living with dementia or who may have physical and mental health needs. On the day of the inspection 16 people were living at the care home. At our last inspection in December 2013 the provider was meeting all of the Essential Standards inspected.

The home was on two floors, with access to the upper floor via stairs or a chair lift. Bedrooms have wash hand basins and vanity units. There are shared bathrooms, shower facilities and toilets. Communal areas included two lounges, a dining room, a garden and outside seating area.

The service had 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.

People told us staff were kind and caring, and treated them with respect. Relatives told us they were happy with the care their loved ones received. There was enough staff to meet people’s needs and the registered manager increased staffing when required. People received care from staff who had received training and ongoing support to help them in their role.

People were supported to eat and drink enough and maintain a balanced diet. The chef was knowledgeable about people’s individual nutritional needs. People who required assistance with their meals were supported. When concerns about people’s nutrition had been identified, responsive action had been taken. People told us the food was nice. People’s care plans provided details to staff about how to meet people’s individual nutritional needs.

People felt safe living at Manor House. The registered manager and staff understood their safeguarding responsibilities. People were protected by safe recruitment procedures as all employees were subject to necessary checks which determined they were suitable to work with vulnerable people.

People were protected from risks associated with their care because staff had guidance and direction about how to meet people’s individual care needs. People had personal evacuation plans in place, which meant people were able to be effectively supported in an emergency. The environment was regularly assessed and monitored to ensure it was safe at all times.

People’s consent to care was obtained and their mental capacity assessed, which meant care being provided by staff was in line with people’s wishes. People who may be subject to deprivation of liberty applications (DoLS) had been assessed and applications applied for. The manager had a good understanding of the MCA and DoLS, however, staff had a limited understanding of how the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) protected people to ensure their freedom was supported and respected.

People had requested improvements to the frequency and variety of social activities, as their social life was not always promoted and social activities were limited. The registered manager was in the process of considering how improvements could be made. People had care plans in place to address their individual health and social care needs. People were involved in the creation and review of their care plan. External health professionals were complimentary of the registered manager and of the care provided by staff. They told us, advice was always implemented as directed.

People’s end of life wishes were documented and communicated. People’s medicines were not always being managed safely. The registered manager’s policy was not reflective of the processes being carried out, documentation was inaccurate and there was no auditing system in place to highlight poor practice so improvements could be made.

People’s confidential and personal information was stored securely and the registered manager and staff were mindful of the importance of confidentiality when speaking about peoples care and support needs. People had a lock on their bedroom door to protect their privacy and security of their belongings.

The registered manager explained she was looking at improving the environment to help promote the principles of dementia care. For example, better signage and colour contrast.  People were protected by effective infection control procedures.

People knew who to speak with if they had any concerns or complaints and felt confident their concerns would be addressed. Staff felt the registered manager was supportive. Staff felt confident about whistleblowing and told us the registered manager would take action to address any concerns. The registered manager took an active role in the running of the service. In the absence of the registered manager, there was a head of care who took reasonability. People were aware of the management structure and who to speak with.

The registered manager had systems and processes in place to ensure people received a high quality of care and people’s needs were being met. There were opportunities for people to provide their feedback about the service, to help ensure the service was meeting their needs as well as assisting with continuous improvement. The Commission was notified appropriately, for example in the event of a person dying or a person experiencing injury.

We recommend the provider considers research and published guidance in relation to the social stimulation of people who live with dementia.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was in response to information of concern received by the Care Quality Commission. At the time of this inspection there were 11 people living at Manor House.

Some of the people who used the service were not able to comment in detail about the service they received due to their healthcare needs. We used our observations to determine how people were cared for and supported at Manor House. We spoke with the registered manager, four staff and two people who used the service.

We found people’s views and experiences were taken into account in the way the service was provided.

People’s care needs were assessed, care and treatment was planned and delivered in line with their individual care plans.

We found staff were supported to deliver care and treatment safely.

The provider notified us of incidents that occurred at Manor House, so that where needed, action could be taken.

Not everyone was able to communicate with us, so we used our observations to determine how people were cared for and supported at Manor House.

We spoke with four people who lived at Manor House, the registered manager/registered provider, a senior carer, a carer, and the chef.

One person who lived at Manor House described one member of staff as “he’s a nice boy, I like him”. Another person told us, “I wouldn’t be any where else”.

We found, people needs were assessed, care and treatment was planned and delivered in line with their individual care plan.

People were cared for in a clean, hygienic environment.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received and had an effective system in place to identify, assess and manage risks to health, safety and welfare of people who use the service and others.

The provider notified us of deaths of people who lived in the home so that, where needed action could be taken.

We spoke to four people who lived at Manor House, people told us “it’s okay”, and “the food is good”. One person told us “I would like to go out to see parts of Cornwall”. Another person told us “I wouldn’t be anywhere else”.

During our inspection we found, people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care and people’s privacy, dignity and independence were respected. We also found people’s needs were assessed, however, care and treatment was not always planned and delivered in line with their individual care plan.

People were not always cared for in a clean, hygienic environment and people who use the service; staff and visitors were not protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were not supported to deliver care and treatment safely and to an appropriate standard.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive and the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We carried out a scheduled inspection of Manor House at an earlier date than planned due to concerns raised about the care of people who lived in the home and the cleanliness of the property. As part of this inspection we made unannounced visits to Manor House on 4 and 12 April 2012. At the time of this inspection there were 13 people living in the care home and seven care staff were employed as well as catering staff.

People who lived in Manor House said they were happy living in the home, felt safe, and were well cared for. Comments from people who lived in the care home and a relative included "I couldn't be in a better place", "we feel like family" and "this is a fantastic home". We observed interactions between the staff and people who lived in the home and saw that staff were friendly, respectful, and attentive to the people they supported. People talked to us about their personal routines, the activities they enjoyed, and the meals provided in the home. People said there were enough staff on duty to meet their physical and health care needs supported by visiting healthcare professionals.