This unannounced inspection took place on 13 and 16 December 2016. A previous inspection on 16 and 22 July 2015 found that not all the standards we looked at were met. We issued requirements in respect of unsafe recruitment practice, not upholding people’s rights and insufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of people.

This inspection found that people’s rights were being protected and there were sufficient competent staff to meet people’s needs. Recruitment practice was improved. However, checks on potential staff members were not comprehensive. Those checks were completed retrospectively following the inspection visits and the recruitment policy reviewed so practice would be more robust.

Neva Manor is registered to provide accommodation and personal care for older people. It is able to accommodate up to 14 people. There were 12 people using the service at the time of the inspection.

Neva Manor has 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.

Individual risks were understood and there were detailed plans in place where a risk was identified. However, although risks from pressure damage were understood and met, there was no formal risk assessment in place. We recommend the service review their policy on protecting people from the risk of pressure damage.

People received their medicines as prescribed, taking into account their individual needs. A community pharmacist advisory visit in August 2016 advised a small number of actions, which had been completed.

People’s care was planned with them and they received care which was centred on their needs and wishes.

People said they were very happy living at Neva Manor and that the care they received was how they wanted it to be. Their care needs were well met. Any health care support people needed was well provided because the staff worked closely with health care professionals.

There were sufficient numbers of staff for the number and needs of people using the service and staffing was flexible. Staff received training that equipped them for their work and they received regular supervision and a yearly appraisal. Staff felt well supported and said they could take any concern or question to the registered manager.

People were protected from abuse because the staff understood what to do if they saw anything which concerned them. People said they had no concerns and felt confident they could raise any complaint. A complaints procedure was available for their use and small issues had been addressed as complaints and dealt with to people’s satisfaction.

People were treated with kindness. People said the staff were kind and helpful one commenting “All very friendly and they take you as they find you. All very kind”. People said they were treated with respect and their privacy was upheld. Staff engagement with people was observed to be very respectful.

People's views were sought throughout the day, through their care plan reviews and through yearly

questionnaires about the service. Questionnaires were also sent to family members, staff and health care professionals. The results were followed up.

Comments about the food were positive. The menu was varied but flexible, in accordance with people’s preferences. People said they could have anything they wanted and they were asked on a daily basis. Specialist diets were managed very effectively.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make deci

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Neva Manor Care Home provides care and accommodation for up to 14 people. The home specialises in the care of older people but does not provide nursing care.

There was a registered manager in place.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Both the registered manager and the provider were available for the whole of the inspection.

Although people told us they felt safe and were happy living in the home. We found the property was poorly maintained.  We saw worn and stained carpets, worn furniture and walls in people’s rooms that needed painting. The registered manager told us they had a plan in place to carry out internal maintenance in the winter months.

People were not protected from acquiring an infection because the cleanliness and infection control in the home was not suitable. We saw soiled toilets and sticky dirty bathroom floors; staff did not follow infection control guidelines. One person had a toilet with a stained floor and urine odour. A new cleaner had been employed and their first day was the day of our inspection.

We observed staff to be caring, kind and compassionate, as well as cheerful.  One person told us “The girls are excellent and I am very happy indeed. I chose to come to this home as it is more friendly”.  All care staff had received training in identifying and reporting abuse.  Staff had a good knowledge of signs of abuse and how to report it. They all stated they were confident any concerns bought to the registered manager would be dealt with appropriately.

People’s health care needs were being met through good assessments and being reviewed regularly. People also told us staff were caring and knowledgeable about their needs. However we found improvements were needed to some people’s individual care plan records to make sure their daily records and care plans provided up to date information to staff.  Whilst we found staff understood people’s needs and provided appropriate care, there was a risk any new staff coming to the service would not have the most up to date information available. We also found the registered manager’s auditing system had not been effective at identifying this issue.

One person told us, “The girls know what I need and how they need to look after me, they have been trained well”. Records showed staff had all received training that supported them to provide the care and support people needed, these included specific needs such as pressure area care and dementia care. The registered manager had plans in place to ensure staff continued to attend training to keep up to date with good care practices.

We found people’s nutritional needs were being met. However, there was not a choice of meals at meal times but people were offered an alternative if they did not like the meal of the day. Everybody spoken with told us they enjoyed the food, two people told us the food was good, whilst one person said the food was fine. One person said it was a bit ‘monotonous’ and they would have liked some alternatives like prawns.  We saw the meals provided were nutritious and well presented. People had made menu suggestions in resident meetings and a satisfaction survey we saw there was an action plan to discuss the suggestion in the next resident meeting.

We observed little in the way of organised activities during our inspection. Regular trips to the community were arranged for one person and other people maintained contact with friends in the community, going out for meals and trips. People had discussed activities at a residents meeting and decided they did not want organised activities on a daily basis. They said they wanted it to be more like being at home when they did not do something organised daily.  However, some comments from some people indicated they would have liked more to do.  One person told us, “Nothing else much happens”, whilst another person said, “I don’t think they do any activities here. I watch telly, yap with people and eat. I would love to play the keyboard but they don’t have one”. We observed some people watching television and others sleeping in their chairs. We did observe a sing-along session with people and staff in the afternoon. The provider had organised a mobile library service for those people who liked to read.

The provider had systems that monitored the care provided and people’s experiences. They took into account people’s views. A survey had been carried out asking people and their relatives about the service they received. Suggestions for change were listened to and actions were taken to improve the service. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Our inspection of 24 September 2013 found people were not protected against the risks associated with the unsafe management of medicines. The provider told us they would review administration practice, recording and management of medicines arrangements.

At this inspection we found new arrangements had been put in place for the administration and management of medicines. These included improved management of stock and records relating to the administration of some medicines. We saw practice around administration of medicines had improved and people's medicines had been reviewed by their GP. We were satisfied the provider had addressed the areas of non compliance we had identified at our last inspection.

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On entering Neva Manor care Home we found the atmosphere warm and welcoming. We spoke with people living at the home, family members and a visiting professional and observed staffs understanding of the care and support needed. The people who used the service we spoke with said that "I have all that I need here, nice bed, lovely food" and staff are "delightful." We saw that the rooms were tastefully decorated with their personal belongings.

We looked at people's individual files which incorporated their personal history, likes and dislikes, care plans and risk assessments and found they encompassed the safety and well-being of people who use the service and utilised the services of external agencies when required.

People who used the service and family members told us that they knew how to raise a concern or complaint and felt confident in doing. They said if they had any issues or concerns they could "talk to the manager." There were policies and procedures in place providing guidance and all staff had received training which was identified on the training schedule.

We reviewed the medication records and found shortfalls in the way daily recordings were completed which may have an impact on the people who use the service.

We visited the home as part of our planned inspection programme. We also followed up on concerns we had received about the service and how people’s nutritional needs were being met.

The seven people we spoke with who used the service were positive about the meals they received. People told us the food “is lovely” and “there is always plenty to eat”. We were also told there was always something available for a snack.

People felt they lived in a home that was as near as it could be to being their own home. Examples of comments people made included, “it is lovely here; I think it’s a marvellous place”. “The staff are kind and I feel very safe”.

We observed staff were approachable and people were encouraged and supported to make their views known to the registered provider/manager and staff. We saw there were varied and thoughtful ways being used to seek people’s views about the quality of service and care they received.

People we spoke with told us they had access to a range of health professionals including GP, dentist, chiropodist and opticians.

We saw people being supported by staff to meet their needs in a caring and individually focussed manner, which was both timely and effective.

Care plans we saw contained clear and comprehensive information about individuals and their needs. Staff told us this enabled them to provide the support and care people needed. Information was current and seen to have been reviewed and updated regularly with the individual person who used the service.

The people that spoke to us were positive about how they are supported by the staff.

People feel that they live in a home as near as it can be to being their own home. Examples of comments people made included, “it is lovely here, I think it’s a marvellous place, it’s a happy atmosphere that you notice straight away”, “this is one of the best places I’ve ever been too”, “this is not just a care home it’s a home, and “it’s the little things that matter here, it’s the extra touches”.

We found that staff are approachable and people are encouraged and supported to make their views known to them.

We saw people being supported by staff to meet their needs. We saw people have their needs met in a timely and effective way by the staff. We saw staff spending time listening to people and talking to them with a warm and respectful approach.

We saw that care plans properly support and guide staff, to ensure people receive the care they need.

We saw that there are thoughtful methods being used to seek people’s views about the quality of service and care they get.

This inspection was undertaken on 16 and 22 July 2015, and was unannounced. The service was last inspected on 11 August 2014 and was found to be in breach of regulation in relation to safety and suitability of premises and cleanliness and infection control. At this inspection we followed up on the breaches, we found that these issues had been addressed. However, we found other breaches in the service which are described in the safe, effective and responsive sections of this report.

Neva Manor Care Home is registered for up to 14 older people, some of whom are living with dementia related conditions. The home is situated near the town centre of Weston Super Mare and is close to local amenities. At the time of this inspection there were 13 people using the service. There was a registered manager in place. 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 was not a safe system in place for the recruitment of staff and some staff had started without appropriate checks being in place. There were also insufficient staff to meet people’s needs. Staff told us they felt busy and did not have time to spend with people. They also felt the staffing levels had been set without looking at people’s needs.

Although care plans contained information about people’s needs and wishes they were not comprehensive. They did not contain specific or sufficient detail, to enable staff to provide personalised care and support in line with the person’s wishes. The manager could not show how people gave their consent to care and treatment or how they made decisions in the person’s best interests. Some people had decisions made on their behalf without the relevant people being consulted. Staff had not received sufficient training to provide a safe and appropriate service that met people’s needs.

People felt safe and told us they liked living at the home. Care staff told us they were confident about recognising and reporting suspected abuse. People were complimentary about the staff and felt staff did their best to support them in a friendly and caring way. People’s privacy and dignity was maintained during care tasks.

Staff supported people to make some choices about their care but care records showed the principles of the Mental Capacity Act 2005 Code of Practice had not been followed because there were no capacity assessments for assessing an individual’s ability to make a particular decision.

We saw staff supported people with care and encouraged them to do things for themselves. Staff knew people’s likes, dislikes and needs. They provided care in a respectful way. People received adequate food and drinks and we observed people being offered choices of what food they ate. However, people and their relatives told us that the choices were limited.

Staff supported people to access health care professionals, such as doctors, dietician, district nurse and optician.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.