Mansion House Care Home is a service registered to provide residential and nursing care for up to 26 older people. The service has a dedicated dementia care unit for 14 people. It also provides respite care for people who need nursing or residential support. Mansion House is a detached property built on two floors. The upper floor is serviced by a vertical lift. There are 26 single bedrooms and the majority have en-suite toilet facilities. At the time of our inspection there were 25 people using the service.

At the last inspection, the service was rated ‘Good’, but the provider was in breach of one regulation. This was Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities ) Regulations 2014. The breach was in relation to poor upkeep of records, ineffective quality monitoring and therefore ineffective risk management.

At this inspection we found the service remained Good and that the breach of Regulation 17 was now met. Records were well maintained and up-to-date, quality monitoring had improved and was more effective and risk management had also improved.

The registered provider was required to have a registered manager in post. On the day of the inspection there was a manager that had been registered for the last four months, but had managed the service since summer 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risk of harm because the registered provider had systems in place to manage safeguarding concerns and staff were trained in safeguarding adults from abuse. Staff understood their responsibilities with regard to reporting safeguarding concerns. Risks were appropriately managed and reduced so that people avoided injury or harm.

The premises were safely maintained and there was documentary evidence to show this. Staffing numbers were sufficient to meet people’s needs and we saw that rosters cross referenced with the staff that were on duty. Recruitment systems were followed to ensure staff were suitable to support people. The registered manager and staff safely managed the systems and practices for handling medicines and the premises were clean and hygienic.

Qualified and competent staff were employed and formally supervised. Their personal performance was checked at an annual appraisal. People’s mental capacity was appropriately assessed and their rights were protected. 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. Records of best interest decisions were not as complete as they could have been and had not been reviewed / updated recently.

People received adequate nutrition and hydration to maintain their levels of health and wellbeing. The premises were suitably designed and furnished for providing care and support to older people and to those living with dementia within the dementia unit.

People received compassionate care from kind staff that knew about people’s needs and preferences. People received the information they needed to support them with their care, were involved in their care decisions and asked for their consent before staff undertook any support tasks. People’s wellbeing, privacy, dignity and independence were respected. This ensured people felt satisfied and were enabled to take control of their lives.

People were supported according to their person-centred care plans, which reflected their needs and were reviewed. They engaged in some pastimes and activities if they wished to. People had very good family connections and support networks. An effectiv

This inspection took place on 9 November 2015 and was unannounced.

The last inspection took place on 25 November 2013, the service was meeting all of regulations we looked at.

Mansion House is registered to provide residential and nursing care for up to 26 people. The home has a dedicated dementia care unit for 14 people. Mansion House is a detached house built on two floors. The upper floor is serviced by a lift. There are 26 single rooms the majority are en-suite. There is a secure garden which people can access.

At the time of our inspection the service did not have a registered manager. A new manager had been in post for two weeks and had applied to the Care Quality Commission to become the registered manager. 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 related to people’s food and drink were poor and contained significant gaps. Although there was evidence of some audits taking place these were not robust and when issues were identified there was no clear record of action taken to rectify them. This meant the provider did not have systems in place to ensure they were providing a good standard of care.

You can see what action we told the provider to take at the back of the full version of the report.

Staffing levels had been reviewed by the provider, they listened to feedback from staff and the manager to ensure they had sufficient staff to meet people’s needs.

Staff knew how to protect people from avoidable harm. Staff had attended safeguarding training and the service had an up to date safeguarding policy which provided staff with clear instruction about the action they would need to take. The service had a whistleblowing policy which meant staff knew how to raise any concerns and who to contact.

People had risk assessments and risk management plans which staff followed to keep people safe. These were well developed and people, their families and the relevant health and social care professionals had been consulted. They provided staff with guidance about how to keep people safe. They balanced the need to keep safe with the right to freedom which meant people were not unnecessarily restricted.

The principles of the Mental Capacity Act (2005) were consistently followed by staff. Consent to care and treatment was sought. When people were unable to make informed decisions we saw a record of best interest decisions. There was a record of the person’s views and other relevant people in their life. The registered manager had a clear understanding of the Deprivation of Liberty Safeguards.

People told us the food was good. We saw people had access to regular drinks, snacks and a varied and nutritional diet. If people were at risk of losing weight we saw plans were in place to manage this and the appropriate healthcare professionals had been consulted.

Care plans contained up to date information which included their preferences, likes and dislikes. Although we were told reviews took place and families were involved we did not see signed review records within care plans.

People had access to a range of activities and were very positive about the role of the activities co-ordinator. Activities were based on interests of people who used the service and we saw the activities co-ordinator was skilled at getting people involved.

People and their relatives told us they knew how to make a complaint but had never needed to. The service had received a variety of compliments. Feedback was sought from people as part of the review of their care.

The manager was keen to make improvements to the service and their staff team demonstrated confidence in them. People and their relatives told us they had met the new manager and even though they had only been there a short time they said the manager was approachable.

We used a number of different methods to help us understand the experiences of people using the service including talking to people who lived at the service, staff, visiting relatives and observing the care provided. We spent time with people using the service and we observed staff being kind and supportive to people.

We spoke with ten people and two visiting relatives they all said they were happy with the care and support provided by the care staff.

We looked at people's care records and saw arrangements were in place to identify those people at a greater risk of poor nutrition and dehydration. People told us they enjoyed the food provided.

Appropriate arrangements were in place in relation to obtaining, handling, storing and administering medication.

We saw that there was enough skilled and experienced staff who, on the whole, met people’s needs in a timely way. This was confirmed by people we spoke with and by staff.

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

Some people living at the home were not able to tell us how they felt due to their needs. We were however able to talk to some people who told us they were happy living at Mansion House. They said they were treated well by the care staff. One person told us,” I need help and they always ask me if they can help me.”

The one relative we spoke with told us, “I came here and knew it was right for my relative. I have not regretted a single day she has been here.” Some of the people who lived here told us they were really looking forward to their Christmas shopping trip; which had been organised for later in the week.

People said they thought everybody was very kind to them. We observed the care staff treating everyone with respect. They were unhurried when supporting people. They sat down and encouraged people to communicate with them.

Our observations showed the people who lived at Mansion House were relaxed and comfortable when the care staff approached them. The care staff we spoke with told us how they would respond to potential or actual abusive situations, to ensure people were safe. One staff member said, “My main priority is for the people who live here to be safe and happy.”

Staff told us they had regular supervision and they ‘worked in a good team.’

People who were able to, told us if they had a problem they would speak to the manager or nurse in charge. We saw evidence of complaints being properly responded to.

People told us that they thought the care at Mansion House was good and that the staff were conscientious and caring. They also told us that they were happy with the environment and the home was kept clean and tidy.

People told us they were involved in decision making in the home and that staff talk to them about their care and ask them if they were alright and that they had everything they needed. People told us that they were treated respectfully and that they felt well cared for.

During a visit to the service, some people said they understood their care and were offered choices. Some said they had seen written care plans. Some people said they were consulted about their care. One person said. 'They keep popping in to check everything is okay and they always ask if it's okay to do something.'

On the day of the visit people said staff treated them with respect and that they were approachable. One person said. 'I talked all this through with the staff and they helped me do what I want.'

However, some people said they had not seen care plans and were unsure about the choices available to them. One person recently complained to the manager that a member of staff did not listen to a request for assistance and left him without the care he needed.

One person said 'It's hard work for the staff, they are sometimes pushed but they always seem to manage and have time for a quip.'

One person said she had been encouraged to manage her own medication following a review of her care. She said she was confident that she could administer her own medication and that she had signed to say she agreed to do so.

People said they felt safe at the home. One person said. 'They look after me and help me do what I want.' One person said ' The staff are very good. They get me dressed in the morning and help me at other times if I ask.'