This unannounced comprehensive inspection of Menwinnion Country House took place on the 14 February 2016.

A previous comprehensive inspection of this service was completed in January 2016. That inspection found that although the service was providing good ‘care’ it required improvement in four of our five key question areas. A number of breaches of the regulation were identified.

In July 2016 a focused inspection was completed to check the required improvements had been made. The focused inspection found significant improvements had been made in most areas but further improvements were required as the service remained in breach of the regulations in relation to the training and induction of staff.

Menwinnion Country House is a large detached building located within its own gardens in the far west of Cornwall. It is registered to provide accommodation and personal care for up to 40 people who do not require nursing care. On the day of this inspection 35 people were using the service. Some people were living with dementia.

The service is required of have a manager who is registered with the Care Quality Commission. Registered managers like registered providers have responsibilities for ensuring the service meets the requirements in the Health and Social Care Act and associated Regulations about how the service is run. There was no registered manager in place at the time of this inspection. This means that it is not possible to the service to achieve a ‘good’ rating in relation to our question is the service well led.

The service was being provided with effective leadership by the acting manager with support from the provider’s nominated individual and training lead. Staff were well motivated and told us they were confident the acting manager would take action to address and resolve any issues they reported. Staff comments included, “You can go to them with anything and they are as good as gold”, “The manager is very approachable. If I have a query I just ask them” and “The manager is doing really well, I can’t fault her.” While people and their relatives also reported they had confidence that action would be taken to address any issue they reported.

People were constantly complimentary of the care and support they received at Menwinnion Country House. They told us, “I would recommend it” and “It’s very good, the Queen couldn’t be treated better than we are.” People were relaxed and comfortable in their home and we observed numerous examples of people laughing and joking with care staff and managers. One person joked, “The staff are awful” before smiling and stating, “I think they do a really good job.”

Relative also praised staff for the compassion with which they provided support and one person’s relative said, “Their attitude is the main thing. Good staff with the right attitude.” Visiting health care professionals told us, “The staff are very good, very attentive” and “I can honestly say they are one of the better residential homes.”

Staff knew people well and understood there individual care needs. People’s care plans were sufficiently detailed and informative and staff told us, “There is enough information in them”. We observed staff supporting one person to manager their anxiety, effectively using techniques described within their care plan. Prior to the inspection managers had identified that daily care and activities records could be improved and had provided staff with additional guidance on record keeping.

There were sufficient numbers of suitably qualified staff on duty on the day of our inspection and rotas showed these staffing levels were routinely achieved. The service had two part time care staff vacancies at the time of our inspection and was in the process of advertising them. Recruitment processes were robust and designed to ensure new staff were suitable for employment in the care sector.

The service employed a part time activities coordinator and people told us there were enough acti

This unannounced focused inspection was completed on the 4 July 2016. This inspection was completed to check that necessary improvements had been made to address and resolve failings identified during the unannounced comprehensive inspection completed on the 19 and 20 January 2016.

This report only covers our findings in relation to those requirements identified during our previous comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Menwinnion Country House on our website at www.cqc.org.uk.

Menwinnion Country House is registered to provide care and support to up to 40 people. The service does not provide nursing care. On the day of our inspection there were 39 people, some of whom were living with a diagnosis of dementia, living in the service. The service is a detached rural house within its own gardens where accommodation is provided on two floors. The building was appropriately decorated and well maintained.

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 this inspection we again found that the service did not have a registered manager. Since our previous one of the service’s managers had left and the deputy manager had been promoted to the role of care manager. The care manager was now responsible for the day to day management of the service and was now based full time in the service’s office. The provider recognised current management arrangements were insufficient and was actively recruiting for additional managerial roles. The providers nominated individual was based in the service on an almost full time basis and the training lead had also visited the service each week to assist with the process of reviewing and updating people’s care plans. The care manager told us, “The director’s ring and visit regularly and I know I can ask for support” and “I can’t ask for any more support.”

Staff told us that the service was now more organised and we saw all staff had received formal supervision since our last inspection. Staff comments included, “[The manager] is brilliant, she is really organised and does not stress. She sorts things out” and “[The manager] is good at what she is doing, everything is running along smoothly.”

At our inspection in January 2016 we found staff training had not been regularly updated, that staff had not received regular supervision and new staff had not completed formal induction training. During this inspection we found that all staff had now received formal supervision. However, we again identified that the service had failed to ensure that staff training was appropriately updated. Our analysis of the training matrix found that some staff had not yet received appropriate training updates. A number of staff who, the provider, had identified as in need or training in specific topics in 2014 had not yet completed this training. In addition induction training for new staff was not provided in accordance with current best practice. Training complete during previous employment had been accepted, without any assessment of current skills, as evidence of the competence of new members of staff.

In January 2016 we found that risks were not effectively managed. First floor windows were unrestricted and individual risk assessments were inaccurate. At this inspection we found that window restrictors had now been installed on all first floor windows and in some ground floor rooms where specific risks had been identified. Risks assessments within people’s care plans had been reviewed and updated since our pervious inspection. Accidents and incidents had been appropriately investigated by the care manager and the service’s emergency proc

This unannounced inspection took place on 19 and 20 January 2015. Menwinnion Country House provides accommodation and personal care for up to 34 people who do not require nursing care. On the day of our inspection there were 32 people living in the service and two people receiving respite care. Some people were living with dementia.

The service is a detached rural building in its own gardens in the west of Cornwall. Accommodation is available on two floors and the building was clean, appropriately decorated and well maintained.

The service did not have a registered manager. The registered manager had accepted a new role as the provider’s training lead before our inspection. One of the service's existing deputy managers had been promoted to lead the home and had applied to the commission for registration. 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 and associated Regulations about how the service is run.

People told us they felt safe and well cared for at Menwinnion Country House. People said; “I think we get incredibly well looked after”, “They really do look after us” and, “I feel safe here.” People’s relatives said, “The staff are charming and very attentive” while Health and Social care professionals who visited the service regularly said; “I do think people are safe here” and, “I don’t have any concerns at all.”

Risks were not effectively managed at Menwinion Country House. Specific risks in relation to unrestricted windows on the first floor had not been appropriately assessed. We raised concerns about people’s safety because of the absence of restriction of window openings, with both the provider’s nominated individual and the service’s management team during the inspection process. Shortly after the inspection we received a notification informing the commission of injuries one person had sustained falling from their ground floor bedroom window. This showed the service had failed to promptly address safety concerns raised during the inspection process.

In addition we found that risk assessment documentation had not been accurately completed and that accidents and incidents that had occurred within the service had not been consistently recorded. Where incidents were recorded they had not been appropriately investigated by managers to identify any trends or areas of increased risk within the service.

Recruitment practices at Menwinnion country house were safe and there were sufficient numbers of staff available to meet people care and support needs. However, staff had not received appropriate training or regular supervision from their managers. Staff told us the training they had received was, “Very hands on.” In the five staff training records we examined only two staff had received safeguarding and first aid training while only three staff had received manual handling training. Staff had not received regular supervision in accordance with the provider’s policies during their induction and none of the recently employed staff had completed the Care Certificate training.

Managers and staff did not fully understand the requirements of the Mental Capacity Act and associated Deprivation of Liberty Safeguards. Managers had correctly identified that one person’s care plan was restrictive and had granted themselves an appropriate urgent authorisation. However, the service’s managers had then failed to make the necessary application to the local authority.

The kitchen at Menwinnion Country House had received a five star food hygiene rating and people told us, “The food is excellent we have a good dinner every day.” We observed that people were offered drinks and snacks throughout the day and that people were offered choices at all meal times.

People told us their care staff were, “

We carried out this inspection to review the actions the provider had taken to address the issues identified during our inspection of 13 May 2014. During our inspection of this service we considered our findings to answer two of our five questions; 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 using the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service effective?

On the day of our inspection Menwinnion Country House was effective. All of the people we spoke were happy with the quality of care they received. People’s comments included “Brilliant, you would not get as good treatment in a first class hotel” and “everything is good here”.

We reviewed the care documentation of three people who used the service and found these documents had been appropriately reviewed to ensure they reflected the individuals care needs. Staff training needs had been identified and appropriate update training provided.

Is the service caring?

The service was caring on the day of our inspection. We saw that people were supported by staff in a quiet, caring and courteous manner. People who used the service told us “Brilliant, you would not get as good treatment in a first class hotel” and “the staff are fabulous, very helpful. I can’t fault them”. A relative who was visiting during our inspection told us told us “X is in good hands”.

Care staff had received appropriate supervision and the nominated individual explained that additional management staff were being recruited to provide existing staff and management with additional support.

During our routine inspection of this service we used the evidence gathered in relation to the five outcomes we inspected to answer our five key questions; 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 information gathered during conversations with people who used the service, relatives, staff and management of Menwinnion Country House.

Is the service safe? We found that Menwinnion Country House had good systems in place to ensure people were protected against the risk of abuse. Staff were aware of the signs and symptoms of abuse and how to report any allegations.

Is the service effective? All of the people we spoke and interacted with who received care from Menwinnion Country House were happy with the quality of care they received. People told us “the staff are brilliant. I am very happy here”.

The care plans did not fully document changes in a person’s condition in a timely manner. Therefore they did not reflect the current needs of people.

Is the service caring? People told us they were well cared for by staff. Their comments included “they are all lovely here”. We heard staff talk with the people who lived at Menwinnion Country House in a kind, relaxed and caring manner.

We found staff morale was high and staff members told us “I love the job and enjoy working with the people here” and “It has a family atmosphere”.

We found people’s likes and preferences in relation to their care had been recorded during the assessment process and we found that staff had complied with people’s wishes while providing care.

Is the service responsive? The service was responsive, we found people were aware of the complaints procedure but had not raised a complaint as they were happy with service they received. People told us “I’ve never needed to make a complaint. They are very good”.

The provider’s complaints policy also included procedures for resolving and recording minor issues raised by people who used the service. We saw these issues had been effectively investigated and resolved.

Is the service well led? The service had appropriate quality assurance systems in place. We saw that audits of the environment and experiences of people who lived at the home had been completed.

Staff told us they felt supported by the mangement team. One person said the home was "Well run".

During our inspection we spoke with the registered manager, area manager, five members of staff, four people who were living at Menwinnion Country House and two people who were visiting their relative.

Each person had a care plan in place which stated their individual needs. People had access to a range of services including hairdresser, chiropodist and GP’S. People who lived at Menwinnion Country House were very complimentary of the staff and told us they were “brilliant” and the care “could not be better”.

The provider had a system in place to ensure training was completed relating to safeguarding people from abuse and protecting their rights. The majority of the staff we spoke with understood the role of the local authority and how to make a safeguarding alert. All of the staff were confident that if they raised any concerns to the manager these would be acted upon.

Staff were supported to provide care to the people who lived at Menwinnion Country House. The views and opinions of the people who lived at the home and/or their representatives were gained to ensure the home was providing a good quality service. Systems were in place to audit the home on a daily basis.

We spoke with six people who lived at Menwinnion to seek their views of the service that they received. We also spoke with three visitors who had called to the home to see their relatives.

People said the home was clean and tidy and that the staff were kind, caring and helpful. One person told us “The food is second to none here, they get you anything you want” and another person commented “It is just like a hotel, I am looked after really well here”.

One visitor told us their relative viewed Menwinnion as their home and said “when we arrive the staff always ask if we want a cup of tea. It is just like visiting X in their own home as they first thing they always did was put the kettle on when we visited”.

People told us they felt safe at Menwinnion and could approach the staff with any concerns or problems they had.

We found people were safeguarded from abuse from the systems and arrangements the registered provider had in place. For example, the recruitment procedures and the training and supervision of staff.

We reviewed all the information we hold about this provider, carried out a visit on 10 January 2012, observed how people were being cared for, talked with people who use services, talked with staff, and checked records.

We spoke to people living at Menwinnion Country House, a visitor to the home, and staff. There were no issues raised by by anyone, all were positive about the care provided and the staff providing the care. People who use the service were moving freely around the home and staff were seen to interact well with them. We saw that people who use the service were very happy to approach any member of staff.

We saw that the routines being observed during the site visit showed that people are able to get up when they want and have choices about where they spend their time.

We saw that residents were spoken with in an adult, attentive, respectful, and caring way. People were seen to have conversations with staff during personal care.

People we spoke with said they couldn’t praise the home highly enough and they felt they could approach staff with any questions or concerns.

Staff told us that training was provided, and all said that they enjoyed working at Menwinnion Country House.

Most people told us they are happy with the service they receive from the home. Some concerns were expressed prior to the site visit which alerted us to the need to complete this responsive review. We have validated some of the concerns, from the evidence we obtained carrying out this review, but we also note there is some continued improvement in the operation of the service since we last visited.