Manor House is a residential care home for up to 30 older people, most of whom live with a degree of dementia. Nursing care can be provided through the local community nursing services if appropriate. 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. Manor House is an old Georgian building set over various floors and extensions with a range of communal spaces leading onto a secure garden and outdoor spaces in Plymouth. South West Care Homes Limited also operates 10 other services in the South West from a head office.

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 ongoing monitoring that demonstrated serious risks or concerns. There had been a recent safeguarding concern resulting in the dismissal of three night care workers but this had been managed well and in partnership with the local authority safeguarding team.

We made a recommendation to ensure that despite audits identifying improvements were required that timely actions were taken to maintain a comfortable and pleasant environment for people.

We carried out an unannounced inspection of Manor House on 3 and 4 July 2018. At the time of the inspection 27 people were living at Manor House. The registered manager was on sick leave during our inspection. The service was being managed by a deputy manager with the support of another registered manager from the provider’s other service locally and a regional manager based at Manor House. They were supported by team leaders and care workers and ancilliary staff. The provider oversaw the running of the service from a head office and completed regular visits and audits. 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 the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. There was a lot of staff interaction and engagement with people, most of whom were living with dementia and unable to tell us directly about their experiences. They looked comfortable and happy to spend time in the communal areas or in their rooms.

People were encouraged and supported to maintain their independence, emphasised by some people being supported to return home to the community. There was a sense of purpose as people engaged with staff, watched what was going on, played games and pottered around the home or went outside. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance.

People were provided with good opportunities for activities, engagement and sometimes trips out. These were well thought out in an individual way and the regional manager was looking at developing a more robust way of ensuring all individuals had their social needs met with the help of a new activity co-ordinator in the near future. People could choose to take part if they wished and when some people preferred to stay in their rooms, staff checked them regularly spending one to one time with them.

People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abus

The inspection took place on the 16 and 17 February 2016 and was unannounced. At our last inspection on the 19 January 2015 we judged the service required improvement. We breached the service in relation to the care and welfare of people who used the service because care was not planned in such a way as to meet people’s individual needs. We asked the provider to report to us what they were going to do to put this right. We reviewed this during this inspection and found this had been addressed.

Manor House can accommodate up to 30 older people who may be living with dementia. On this inspection 26 people were living at the service.

A registered manager was employed to manage the service. 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 they were safe and happy living at Manor House and were looked after by staff who were kind and treated them with respect, compassion and understanding.

People felt in control of their care. People’s medicines were administered safely and they had their nutritional and health needs met. People could see other health professionals as required. People had risk assessments in place so they could live safely at the service. These were clearly linked to people’s care plans and staff training to ensure care met people’s individual needs. People’s care plans were written with them, were personalised and reflected how people wanted their care delivered. People’s end of life needs were planned with them. People were supported to end their life with dignity and free of pain.

Staff knew how to keep people safe from harm and abuse. Staff were recruited safely and underwent training to ensure they were able to carry out their role effectively. Staff were trained to meet people’s specific needs. Staff promoted people’s rights to be involved in planning and consenting to their care. Where people were not able to consent to their care, staff followed the Mental Capacity Act 2005. This meant people’s human rights were upheld. Staff maintained safe infection control practices.

Activities were provided to keep people physically and cognitively stimulated. People’s faith and cultural needs were met. The service was adapted to meet the needs of people so they could live as full a life as possible.

There were clear systems of governance and leadership in place. The provider and registered manager ensured there were systems in place to measure the quality of the service. People, relatives and staff were involved in giving feedback on the service. Everyone felt they were listened to and any contribution they made was taken seriously. Regular audits made sure the service was running well. Where issues were noted, action was taken to put this right.

We inspected Manor House on the 19 January, the inspection was unannounced.

Manor House is a registered care home for up to 30 older people. At the time of the inspection 27 people were living at Manor House some of whom were living with dementia. 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.

Manor House is an older style property near the centre of Plymouth. Parts of the home had been redecorated and where this had occurred it had been done with regard to people’s dementia needs. There were signs to assist people to move around the home independently and bedroom doors were personalised. Some parts of the home were in need of redecoration and we were told there were plans in place for this to happen. We found two areas of the home which were unsafe for people. We have made a recommendation about keeping people safe in their environment. We will follow up recommendations at the next inspection.

People told us they felt safe and were happy living at Manor House. One person told us, “I like it here very much. The girls [staff] are wonderful, there’s nothing they wouldn’t do for me. I’m very happy here, the food is lovely and the activities fun.”

Staffing levels were sufficient to meet people’s needs. There was a robust recruitment system in place which protected people from the risk of being supported by staff who were unsuitable.

Staff knew the people they supported well and had a good understanding of their needs. We observed staff took account of people’s communication preferences and were thoughtful and compassionate in their approach to them. One person told us, “I get on very well with the staff. They couldn’t look after me better if I was their own family.”

Some people were having their liberty restricted without the proper authorisation as laid down by the Mental Capacity Act (2005) and associated DoLS. The registered manager told us they would address this in the very near future.

People were able to make choices about how and where they spent their time. They told us they went to bed and got up at a time that suited them. People were encouraged to take part in a wide range of activities within the home although there had been no activities outside of the home for some time. There were plans to hire a vehicle which would make this possible in the future.

Care plans held detailed information and guidance for staff on how to support people. However systems to ensure staff were up to date about any changes in people’s needs were inconsistent. We saw gaps in night shift notes and the way in which care plans were written and updated meant the most recent information could be difficult to locate.

The registered manager was available for staff, people and relatives if they wanted information or advice. We observed them in the home talking with people and their relatives and noted the conversations were friendly and relaxed.

Staff told us they were well supported and a close team with a mix of skills and experience. Training was thorough and included subject areas specific to the needs of people living at Manor House.

Regular audits took place within the home. These records were reviewed regularly by the provider. This meant any trends were highlighted and could be acted upon.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The actions we have asked the provider to take are detailed at the end of the full version of the report.

People told us "I couldn't be happier here"; "So well looked after, 1st class"; "I like a drink (alcoholic) and am allowed this"; "If staff have to do anything privately for me they always shut the door"; "Staff are polite and courteous."

We found people were able to express their views about the service through resident meetings and six monthly questionnaires. Some people were also involved in the recruitment processes for new staff.

We found that people were involved in the assessment process and in the care planning processes but assessments were not reviewed to ensure the safety and welfare of people living at the Manor House.

We found people had their nutritional requirements assessed and action was taken to ensure people received the support they required to maintain their nutritional needs. People at the Manor House had a well balanced diet.

Staff were well trained, supported in their roles and had access to regular informal and formal meetings with their manager to discuss clinical situations and their own professional development.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming.

We found that people were treated with dignity and respect. Their individuality was recognised and they were supported to make their own choices.

Care records were written with people and reflected their wishes. They were written in a style that people could understand. People using the service and their relatives confirmed they felt involved in their formulation.

We found the staff understood people’s needs and knew how to support them. One person using the service said, “They are always polite, friendly professional and know what I want. Nothing is ever too much trouble.”

We saw that suitable systems were in place to manage medicines.

We found disclosure and barring service checks had been carried out. This meant people using the service were appropriately protected.

We saw complaints information was available and people confirmed they felt able to raise a concern.