We carried out an unannounced comprehensive inspection on 29 January 2019.

Manorfield Residential Home is a care home without nursing for up to 28 people. On the day of our inspection there were 27 people living at the service. It specialises in care for older people some who are living a physical disability, sensory impairment and living with dementia.

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.

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 the last inspection on 2 August 2016, the service was rated 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. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service remains Good:

We met and spoke with most of the people living in Manorfield Residential Home during our visit, however, not all people were able to fully verbalise their views. We therefore spent time observing people with the staff supporting them. Others could tell us about the care and support they received. Staff told how they used other methods of communication with people who could not verbally express their views, for example the use of pictures.

People remained safe at Manorfield. People who were able to told us they felt safe living there. Comments received about the service included; “You don't ever feel left on your own, so I feel safe.” Relatives said; “We know our relative is safe and happy and we can visit or call any time and staff are always friendly and helpful” and “My relative is safe.”

People continued to receive their medicines safely from staff who had received regular training. People were protected by safe recruitment procedures. This helped to ensure staff employed were suitable to work with vulnerable people. People, relatives and the staff team confirmed there were sufficient numbers of staff to keep people safe. Staff confirmed they could meet people’s needs and support them when needed.

People’s risks were assessed, monitored and managed by staff to ensure they remained safe. Risk assessments were completed to enable people to retain as much independence as possible.

People continued to receive care from a staff team that had the skills and knowledge required to effectively support them. Staff had completed safeguarding training. Staff without formal care qualifications completed the Care Certificate (a nationally recognised training course for staff new to care). The Care Certificate training looked at and discussed the Equality and Diversity and Human Rights policy of the company.

People continued to receive a caring service. People were observed to be treated with kindness and compassion by the staff who valued them. The staff, many of whom had worked at the service for several years, had built strong relationships with people. All staff demonstrated kindness for people through their conversations and interactions. Staff respected people’s privacy. People or their representatives, were involved in decisions about the care and support people received.

People were supported to have maximum choice and control of their lives and, staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People’s wishes for their end of life were clearly documen

Manorfield Residential Home is registered to provide support and accommodation for up to 28 people. It provides a service to people which includes older people, people living with a physical disability, sensory impairment and some people living with dementia. It also provides respite care. On the day of our visit there were 27 people who used the service.

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.

People and relatives said they felt safe and secure and had no concerns about safety at the home. Staff understood local safeguarding procedures. They knew what action to take if they were concerned that someone was at risk of abuse. Risks to people’s safety were assessed and reviewed. People received their medicines safely.

Thorough recruitment processes were in place for newly appointed staff to check they were suitable to work with people. Staffing numbers were maintained at a level to meet people’s needs safely.

Staff received regular training and there were opportunities for them to study for additional qualifications. Staff were supported by the management through supervision and appraisal. Team meetings were held and staff had regular communication with each other at handover meetings which took place between each shift.

Staff understood how people’s capacity should be considered and had taken steps to ensure that people’s rights were protected in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). We found the registered manager understood when an application should be made and how to submit one.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals.

People were supported by kind and caring staff who understood their job role. Staff took time to engage with people, providing reassurance and support. People had developed relationships with staff and told us the staff were kind, caring and that they treated them respectfully. Staff understood how to care for people in a sensitive way.

People were involved as much as possible in planning their care. Care plans provided information about people’s support needs. The registered manager and staff were flexible and responsive to people's individual preferences and ensured people were supported to live the life they wanted, in accordance with their needs and abilities. People were encouraged to maintain their independence and to participate in activities that interested them. People were supported to express their religious beliefs and to maintain their cultural or religious needs

The service was well led. The registered manager operated an open door policy and welcomed feedback on any aspect of the service. The registered manager senior staff monitored the delivery of care.

A system of audits were in place to measure and monitor the quality of the service provided and this helped to ensure care was delivered consistently. Suggestions on improvements to the service were welcomed and people’s feedback encouraged.

There was a clear complaints policy and people knew how to make a complaint if necessary.

We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We saw people were treated with dignity and respect by the staff. People told us they trusted the staff and felt safe when staff supported them. The service had a robust safeguarding policy and staff received safeguarding vulnerable adults training as part of their induction. Staff told us how they would identify and respond to any safeguarding concerns. Management and staff were aware of their responsibilities to report safeguarding concerns and demonstrated who they would report these to.

Systems were in place to ensure managers and staff responded to incidents and accidents, concerns and complaints. These meant risks to people were identified and actions were put in place to reduce those risks. The home had identified procedures to manage Deprivation of Liberty Safeguards. Where they had identified people lacked capacity to make decisions they had not recorded their assessment of this. Staff had received relevant training in the Mental Capacity Act and Deprivation of Liberty Safeguards.

The service was purpose built to accommodate people with physical support needs and was all on one level. People could access all parts of the building through corridors. There were alcoves in the corridors where people could sit if they need a rest or wanted to be away from the main communal areas. The service was in good decorative order and showed it was well maintained.

The provider and manager undertook regular checks on the service to include the safety of the environment, risk assessments, confidentiality and content of records. The service was safe, clean and hygienic and staff regularly carried out regular infection control audits.

Is the service effective?

People's care needs were assessed and care plans were written based on the person's identified needs. One person told us: "I was involved in writing my care plan and I could tell them what was important to me and they listened to me." Where people required specialist equipment this had been provided. People were referred to see health care specialists when necessary.

A relative told us: "I do not worry about my relative being here as I know they are receiving the best care available. The staff always pick up if they are not well and they are seen immediately by a GP."

Is the service caring?

We saw staff engaging in conversation with people as they supported them. People were addressed by their preferred name and were asked before staff supported them. A person told us: "The staff are all very helpful and ask me what I want before they help me." A relative told us: "The staff at Manorfield are wonderful. I visit regularly and have never seen or heard anything but kindness and compassion." We observed people were encouraged to maintain their privacy and staff knocked on their room doors before entering.

We saw satisfaction surveys from people and their relatives which were all positive. Where concerns had been raised we saw how these had been addressed.

People were involved in their care plans and where necessary best interest meetings were held to ensure decisions made on behalf of the person were supported by professionals and relatives.

Is the service responsive?

There were a number of arranged activities available to people during the week. People were able to choose if they wished to join in group activities. The service had their own minibus and people told us they went out to attractions and activities of their choice.

People told us they knew how to make a complaint although they had not made any complaints. The service had a complaints policy and the manager told us how they would respond to a complaint. The service had a suggestion box for people and their relatives. We saw the service had received a comment about the chairs in the corridors being too low and saw how the service had responded to this by ordering new chairs.

Each person had an essential information record which could go with them should they be admitted to hospital. This contained essential information about the person's communication, likes and dislikes.

Is the service well-led?

We saw records of how the service worked well with visiting health professionals and other agencies. A relative told us: "On the rare occasion I have had to make a comment about my relative's health, management have arranged for the GP to visit and made changes to the care plan immediately."

The provider had a quality assurance system in place where they carried out an audit every month. This produced an action plan which we saw had been responded to by the manager. This meant the quality of the service was monitored and action taken to improve the quality of the service provided on a regular basis. We saw examples of an increase in support for one person having a spate of falls. This showed the service was learning from accidents and incidents and responded appropriately to these.

Staff told us they received regular supervisions and appraisals and were encouraged to attend training events and undertake professional qualification courses. One member of staff told us: "Communication is great here and we have a good staff team. I know I can speak to the manager at any time and they will listen to what I have said." This helped to ensure people received a consistent standard of care and a good quality of service.