We inspected this service on 17 and 18 January 2017. The inspection was unannounced.

The service provides accommodation, nursing and personal care for up to 52 older people who may live with dementia or physical disabilities. Forty-six people were living at the home on the day of our inspection.

The registered manager had been in post for seven years. 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 our previous inspection in November 2015, we identified improvements were required in keeping people safe, in delivering effective care and treatment and in the leadership of the service. We gave the home an overall rating of requires improvement. The provider sent us an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection, we checked whether the actions they had taken were effective.

Since our previous inspection, the registered manager had recruited additional staff. There were enough suitably skilled and experienced staff on duty to meet people’s care and support needs safely and effectively. The registered manager had sufficient time and support from the provider to carry out their management role effectively.

People’s medicines were managed, stored and administered safely and staff kept accurate records of people’s treatment, which evidenced risks to people’s health and wellbeing were managed effectively.

The registered manager assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. Accidents, incidents and falls were investigated and actions taken to minimise the risks of a re-occurrence. The premises were regularly checked to ensure risks to people’s safety were minimised.

People were safe from the risks of harm, because staff understood their responsibilities to protect people from harm and were encouraged and supported to raise concerns under the provider’s safeguarding and whistleblowing policies.

The registered manager checked staff’s suitability to deliver care and support during the recruitment process. People’s needs were met effectively because staff had the necessary skills and experience and received appropriate training and support from the registered manager.

Staff understood people’s needs and abilities because they worked with experienced staff until they knew people well. Staff were encouraged to reflect on their practice and to develop their skills and knowledge, which improved people’s experience of care.

The registered manager understood their responsibility to comply with the requirements of the Deprivation of Liberty Safeguards (DoLS). They had applied to the Supervisory Body for the authority to restrict people’s rights, choices or liberty in their best interests.

People were offered meals that were suitable for their individual dietary needs and met their preferences. They were supported to eat and drink according to their needs. Staff monitored people who were at risk of poor health and obtained advice and support from other health professionals to maintain and improve their health.

People were cared for by kind and thoughtful staff who knew their individual preferences for care and their likes and dislikes. Care was planned to meet people’s individual needs and abilities and care plans were regularly reviewed and updated when people’s needs changed. Complaints were responded to, investigated and appropriate actions taken to the satisfaction of the complainant.

Staff were guided and supported in their practice by a management team that they liked and respected. Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice.

The prov

This inspection took place on the 26 January 2015 and was unannounced.

Mockley Manor is registered to provide both nursing and personal care for a maximum of 52 older people. 45 people were living in the home at the time of our visit.

We last inspected the home in August 2014. After that inspection we asked the provider to take action to make improvements in care provision and to ensure people’s needs were met by sufficient numbers of appropriately skilled staff. At this inspection we found improvements had been made in these areas, but further improvements were still required.

A registered manager was 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 told us they felt safe living at Mockley Manor and staff understood their responsibility to report any observed or suspected concerns. Where potential risks had been identified with people’s care, we saw the correct equipment was in place to reduce the risks such as mobility aids.

Although staff thought there were sufficient staff to meet people’s needs safely, we found there was a delay in responding to requests for support. Improvements were needed to ensure people received the same level of care throughout the day.

Staff received training in areas considered essential to meet people’s needs safely and consistently. However, there were limited training opportunities to develop staff knowledge of specific health issues. Staff had not received training in the Mental Capacity Act 2005 and their understanding of the legislation was not always clear.

The manager had made appropriate applications to the local authority in accordance with the Deprivation of Liberty Safeguards and was following legal requirements.

Staff were caring and compassionate in their approach to people. People were given choices about how they wanted to spend their day so they were able to retain some independence in their everyday life. Family and friends were able to visit when they wished and staff encouraged relatives to maintain a role in providing care to their family member.

There were a range of activities available for people living in the home that promoted their wellbeing. Staff responsible for providing activities were enthusiastic and encouraged the wider community to support the home.

Staff understood people’s healthcare needs and people were supported by external healthcare professionals to ensure their needs were fully met.

There was a stable management team in place who were consistent in their understanding of the challenges faced by the service. Staff felt supported by the registered manager and told us they would feel confident to raise any concerns or issues.

There were processes in place to assess the service which fed into an action plan to ensure improvements were made in the quality of service provided.

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

Two inspectors visited Mockley Manor which is registered to provide personal care and nursing care for up to 52 people.

During our visit we spoke with the manager, the deputy manager, five staff, nine people who used the service and two relatives.

We spent time in the communal areas of the home and observed the care and support provided to people. We looked at care records and staff records. We used all the information we gathered during our visit to answer 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. If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at Mockley Manor told us they felt safe living there. One relative told us, “The doors are always open so we can have a word. That’s what’s nice about it, the open atmosphere.” During our visit we found people appeared comfortable and relaxed around staff.

Staff we spoke with demonstrated a good understanding of abuse and the different forms abuse can take. Staff told us they would report any concerns to the senior on duty or the management team.

The service had undertaken the necessary recruitment checks to make sure people were protected from possible harm by the staff delivering care to them.

We saw appropriate Deprivation of Liberty Safeguards applications had been made when any potential restrictions on a person’s liberty had been assessed.

Is the service effective?

People and the relatives we spoke with were generally positive in their comments about the home. One person told us, “It is alright. It is passable.” Another said, “I think it is well run and it has every facility you need.” Another person described the home as “beautiful”.

We spoke with staff who told us they had not read or accessed people’s care records on a regular basis. This had the potential to place people at risk of receiving inappropriate care and support.

There were periods of time when we observed people were left on their own without staff presence.

The frequency of the staff training programme meant we could not be sure staff were up to date with current best practice in some areas.

Is the service caring?

There was a range of activities available within the home. On the day of our visit people in communal areas were engaged on both a group and individual basis. People were offered physical, mental, visual and sensory stimulation.

There was little evidence of social stimulation for those people who were looked after in bed or chose to stay in their rooms.

During our visit we saw staff provide kindly and caring reassurance to people who were upset.

Is the service responsive?

Care plans were in place in relation to people’s mobility, continence, nutritional needs, and personal care needs. We saw where people had specific health needs there were plans in place informing staff how to meet those needs. Care plans were reviewed regularly by the nursing staff.

People told us they sometimes had to wait for staff to respond to call bells, especially in the afternoon.

Is the service well-led?

After a period of recruitment to the home, staff spoke positively about the staff team now in place. Staff we spoke with confirmed they felt supported by the management team. One staff member told us, "We all work as a team and it is getting better. Rachael (the manager) is absolutely marvellous. You couldn't ask for a better manager. She is very supportive."

When we visited Mockley Manor we spoke with seven people who used the service and two relative’s to obtain their views about the home. We also spoke with the operations manager, the manager, the deputy manager, three care staff, the chef and a member of the administration staff.

People who lived at the home told us, “I am happy here, it’s nice” and “They look after me very well.”

We saw staff were kind and attentive when they delivered care to people. We saw people were supported and encouraged to maintain their independence.

We looked at three people’s care records and saw their care plans reflected their personal needs. We saw the members of staff supported people as detailed within their care plans.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. Some staff told us they had not had a formal meeting with the manager on a one to one basis.

We found the service was well led and had systems in place to monitor the quality of service provided at Mockley Manor.

We inspected this service on 30 November and 3 December 2015. Our inspection was unannounced.

Mockley Manor is registered to provide both nursing and personal care for a maximum of 52 older people. The home was set out over two floors and there was a separate unit for people living with dementia called Namaste. There were 39 people living in the home at the time of our visit.

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.

We last inspected the home in January 2015. After that inspection we asked the provider to take action to make improvements to ensure people’s needs were met by sufficient numbers of appropriately skilled staff. At this inspection we found improvements had been made, but further improvements were still required.

Most people were happy with the staff, but acknowledged that staff were busy and they sometimes had to wait for assistance with personal care. Staff we spoke with said there were enough staff to support people safely and ensure they received the care they needed. Further improvements were needed in the allocation of staff to ensure there was oversight of communal areas at critical times.

People told us they felt well cared for and safe living at Mockley Manor. People told us staff were respectful and kind towards them and staff were committed to providing a caring environment. Staff protected people’s privacy and dignity when they provided care to people and staff asked people for their consent before care was given. There was a programme of activities and entertainment to support people’s social needs. Friends and family were welcomed into the home and encouraged to maintain a caring role in their relative’s life.

Care plans contained information for staff to help them provide the individual care and treatment people required, however not all records supported people’s changing needs. The management team had recognised this was an area for improvement and was taking action to address this.

Staff had a detailed handover between shifts when they were updated about people’s care needs so they could respond appropriately. Records of care and treatment delivery did not demonstrate that plans to manage identified risks were being consistently followed.

Assessments had been completed to determine people’s capacity to make certain decisions. The provider was meeting their requirements set out in the Deprivation of Liberty Safeguards (DoLS).

People were referred to other healthcare professionals and received their medicines as prescribed.

Care staff received training and support to meet the individual needs of people effectively. A newly recruited nursing team were being supported to ensure their competencies, but required a high level of clinical support to develop their confidence.

The registered manager was providing clinical and nursing support in the home which impacted on the effectiveness of their management of the service. Where checks, audits and feedback from people had identified issues, timely action had not always been taken to implement improvements. Following our inspection, the provider told us they were going to recruit two new clinical leads to the home to take over some of the registered manager’s clinical responsibilities. This would enable the registered manager to concentrate on the management of the home. We will continue to monitor the service to ensure these improvements are implemented and maintained.