Manton Hall is a residential care home for people living with dementia. The accommodation is spread over two floors with the main communal areas situated on the ground floor.

At the last inspection in September 2016, the service was rated Good. At this inspection we found that the service remained good.

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.

There were sufficient number of staff that had received the training and support that they required to provide effective care to people. Staff had been subject to appropriate recruitment procedures to ensure that they were of good character. People were protected from the risk of harm because staff were confident in recognising issues and reporting their concerns to maintain people’s safety.

People received personalised care and support and had detailed plans of care in place to guide staff in providing their care. People’s needs were monitored closely and their plans of care reviewed to ensure they received appropriate care and support. People had been involved in developing their plans of care which meant that people received consistent and personalised support. 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 were supported to access healthcare professionals and to maintain their health and well-being. Staff were vigilant in noticing changes to people’s health. People were supported to have sufficient amounts to eat and drink to help maintain their health and well-being.

Staff took time to get to know people and ensured that people’s care was tailored to their individual needs. People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles effectively. The quality of the service was monitored by regular audits carried out by the registered manager and by the provider.

We inspected this service on 15 and 16 September 2016. The inspection was unannounced.

The service was last inspected on 6 February 2015. At that inspection we found that improvements were needed regarding the outcomes of safe, effective, caring and responsive to fully meet with regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to implement changes to ensure that they met the regulations for these outcomes. We therefore only checked these four outcomes at this inspection to ensure that appropriate changes had been taken as required.

At this inspection when we reviewed the areas for safe, effective, caring and responsive, we found that actions had been taken to improve the quality of the service, however, we found that some strengthening of systems relating to medicines were still needed.

Manton Hall provides accommodation for up to 30 older people, some of whom

were living with dementia. On the day of our inspection there were 30 people who lived at the service.

The service had a 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.

People were protected from harm. At this inspection people who used the service told us that they did feel safe. People said that they thought there were enough staff available to provide support and assistance. However, they would also like to have time to just sit and chat with staff as they were often kept quite busy. Any risks associated with people's care, support or daily routines were assessed and action then taken to either eliminate or reduce such risks.

All members of staff had received appropriate training that enabled them to meet the needs of people who used the service. People received their medicines as prescribed by their GP, however, some improvements were still required regarding the safe handling of medicines.

People were supported and encouraged to make decisions about their care. The provider was aware of their responsibility to meet the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People's personal choices were fully detailed in care plans. People were offered and encouraged to participate in activities and also to follow their interests and interests.

We carried out an unannounced inspection of the service 6 February 2015.

Manton Hall provides accommodation for up to 30 people who require personal care. On the day of our inspection 27 people were using the service.

There was not a registered manager employed at the service. There was an acting manager who was in the process of applying to become registered. 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.

During our last inspection 24 April 2014 we asked the provider to take action to make improvements to protect people living at the service. The provider was not meeting five regulations of the Health and Social Care Act 2008. These were in relation to people’s care and welfare, safeguarding people from abuse, infection control, supporting workers and assessing and monitoring the quality of care provision. The provider sent us an action plan to tell us the improvements they were going to make. During this inspection we found that improvements had been made.

People told us they felt safe and risk was assessed. Management plans were in place and staff were following these so that risk was reduced. Staff knew how to recognise the signs of abuse and knew what action to take to protect people.

Staffing numbers and the mix of their skills met the needs of people who used the service and kept them safe.

Arrangements in place for the recording, handling, administration and disposal of medicines were not always safe and guidance for staff on the use of medicines prescribed to be used ‘when required’ was not clear.

Staff had received most of the training they required to meet people’s needs and keep them safe. They were supervised by their line manager and had their competency assessed. People were asked for their consent to care and treatment and were able to make choices. Some people had not had their mental capacity to make decisions assessed and some staff were not clear about current guidance.

We have made a recommendation that the provider considers current guidance about the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

People were supported to eat and drink enough and to maintain a balanced diet. People were offered a varied diet and were offered choice and flexibility. People said they liked the food provided.

People had access to the healthcare services they required and staff made appropriate referrals and in a timely way.

People said that staff were caring and most of the interactions we observed were kind and respectful. One person became anxious and distressed but staff did not respond to this or take appropriate action until we asked them to. While people were offered choice about how they spent their day, people were not actively involved in making decisions about their care and support. The acting manager was taking action about this.

New care planning documentation was being introduced so that care plans could be personalised. People said they received care and support in the way they preferred. Opportunities for people to pursue their hobbies and interests were limited.

Complaints were investigated and used as an opportunity for learning. Action was taken to improve the service.

Systems were in place to monitor the quality of service provision and this included seeking the views of people who use the service. People said the acting manager was approachable and accessible.

At our inspection we asked five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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 using the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

We observed that people were treated kindly and respectfully by staff. Staff were attentive to people’s needs and offered people choice. People we spoke with felt safe. Staff knew how to report suspected abuse and who to report to. Some staff were unsure about how to recognise the signs of abuse. There were times when there no staff in attendance in the lounge area. Some people were dependent on staff to meet their needs and ensure their safety because of physical of cognitive disability.

There was an annual programme of audits to monitor the quality of service provision. Staff were not involved with or aware of the audits undertaken.

There was limited evidence available to demonstrate that learning from incidents / investigations took place and appropriate changes were implemented. This increases the risk of harm to people and fails to ensure that lessons are learned from mistakes.

People were not always cared for in a clean and hygienic environment. There were not enough domestic staff on duty to clean all areas of the home on a daily basis. We found significant breaches to the expected standard for infection prevention and control.

Staffing numbers were not always sufficient to meet people’s needs or keep them safe. One person told us they had to wait for staff to attend to them at certain times of the day.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. This means that when people have their liberty deprived in order to keep them safe, this was only done following a best interest assessment carried out by the local authority DoLS team. At the time of our visit there were two people using the service who required a DoLS authorisation. However, the actions staff should take to manage the deprivation in the least restrictive way was not recorded in one person’s care plan.

People were not fully protected from the risks of receiving care that was inappropriate or unsafe. Staff had not carried out risk assessments for three people who had recently moved in.

Is the service effective?

People’s health and care needs were assessed before they moved in, but care plans for three people who had recently moved in had not been completed. Some care plans had not been reviewed regularly. Care plans were therefore not able to support staff consistently to meet people’s needs.

Staff had not received all the appropriate training they required to meet people’s needs or to keep them safe.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. Some staff members told us that they did not always have the time to spend with people because they were so busy.

People’s preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support could not always be provided in accordance with people’s wishes.

Is the service responsive?

People had been supported to maintain relationships with their friends and relatives.

People knew how to make a complaint if they were unhappy. People told us that staff

would listen to them and take appropriate action.

An activities organiser had recently been appointed. We were told that the activities organiser would be responsible for arranging monthly residents meetings so that people could provide feedback about their experience of care, treatment and support.

Is the service well-led?

The service had a quality assurance system, records seen by us showed that not all of the shortfalls identified had been addressed. The system did not systematically ensure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

We carried out this inspection to follow up non compliance from our inspection of 17 October 2013. We spoke with three people who used the service. They told us they were happy with the care and support they received and said they liked the staff. We observed staff interacting with people who used the service. We saw that staff were respectful and helpful. People who used the service appeared relaxed and at ease with the staff on duty.

Care plans and risk assessments were up to date and reflective of people's needs and preferences. Staff were taking appropriate action in response to risk of malnutrition and or dehydration. Staffing numbers had increased since our last inspection. This meant that there were enough staff to meet people's needs.

We spoke with two people who used the service and to two relatives. People told us they liked the staff and received the care and support they required. One person said "Its alright, the staff are pretty good". A relative told us they were always made welcome when they visited and liked the staff. We saw that care records were in the process of being updated. Some care plans and risk assessments were not reflective of people's current needs.

People told us they liked the meals provided and said there was always a choice. Some people had not had their risk of malnutrition assessed for some time. One person had lost a lot of weight but we could not find evidence that appropriate action had been taken in response to this.

Staff knew how to recognise the signs of abuse and what action to take when abuse was suspected. People told us they felt safe living at Manton Hall. The provider had processes in place to monitor the quality of service provision. This included seeking the views of people who use the service.

We spoke with two people who used the service and to a relative. People were satisfied with the service they received. One person told us they liked the staff and had made many good friends. A relative told us that staff were always helpful and accommodating. Another person said they liked the staff and liked the food. People were provided with opportunities to engage in meaningful activities. Staff had received the training they needed to meet the needs of people who used the service.

People who used the service told us they were happy with the service they received. People told us they liked and got on well with the staff.

People spoken with told us they were satisfied with the servcie they received and praised the staff employed at Manton Hall.