The inspection was carried out on 29 May and 01 June 2018. The first day of the inspection was unannounced.

The home is in an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had en-suite toilet, wash basin, and shower. Attached to the building but not owned or operated by the same provider is a separate sheltered housing building. This is not accessible from the home other than in an emergency.

The manor is registered to provide accommodation and nursing or personal care for up to 59 people. 34 people were living at the home at the time of the inspection. Of these only six were assessed as needing nursing care.

At our last comprehensive inspection of the home in May 2017 the service was rated requires improvement overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 11, 12 and17.

This was because the provider did not have appropriate arrangements to maintain a safe environment, at our focused inspection of the home in July 2017 we found further breaches of safety including fire doors and staff training in moving and handling people and fire safety.

We had also found that the provider did not have appropriate arrangements in place for people to consent to their care and appropriate arrangements were not in place to safely manage the home.

After that inspection the provider wrote to us to say what they would do to meet its legal requirements. At this inspection we identified that improvements had been made and the provider was no longer in breach of regulations 11 and 12. We found that although improvements had been made to the management of the home there were still breaches of regulation 17 and a breach of Regulation 18 of the Health and Social Care Act 2006.

The home 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. The manager had been registered in January 2018 and was at the time of the inspection working their notice.

During the inspection we spoke individually with 10 of the people living at the home and with five of their visitors. We spoke with 17 members of staff who held different roles within the home. We examined a variety of records relating to people living at the home and the staff team. This included four care plans relating to people living there and five staff recruitment files. We also looked at records and systems for checking the quality and safety of the service.

People living at the home were complementary of the environment and of staff who supported them. One person commented “Lovely, well decorated. The people are very kind. The food is excellent.” Another person told us “It’s marvellous. I am very impressed.” People also told us that at times they did not think enough care staff were available to provided support. One person told us, “They are always short of staff, it puts pressure on them. They have to rush you in a morning.”

Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. People felt safe living at The Manor and staff knew what action to take if they felt people were at risk of abuse. People knew how to raise a concern or complaint and felt confident to do so.

People’s medication was safely managed and they received it on time and as prescribed. People’s health care was monitored and they received the support they needed with their health and personal care.

A series of assessments of people’s care needs had been carried out and used to form the basis of a care plan advising staff on the support the person required. The quality of information within plans

We had previously carried out an unannounced comprehensive inspection of this service on 8 and 9 May 2017. Breaches of legal requirements were found relating to the safety of the service, the ways that consent to care was managed and the governance of the service. We undertook this focused inspection in response to concerns about the high level of safeguarding referrals made in relation to the care provided by the home since that inspection. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Manor House Care Home on our website at www.cqc.org.uk.

This inspection took place on 12 July 2017 and was unannounced.

The Manor House Care Home is an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had been refurbished during 2015 and had an en-suite toilet, wash basin, and shower.

The service is registered to provide accommodation and nursing or personal care for up to 59 people and 37 people were living at the home when we visited. The people accommodated were older people who required 24 hour support from staff. The home also provided respite stays for people who usually lived in their own homes. The home is part of the range of services provided by Bupa Care Homes.

The home did not have 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. The Regional director and temporary manager told us that the company was seeking to recruit a home manager and a new clinical services manager had recently been appointed and was awaiting recruitment checks prior to commencing in post.

We looked at the high number of safeguarding concerns that had occurred since our comprehensive inspection in May 2017. We did have some concerns about the actions that had led to these situations but we could see that the temporary manager was conducting detailed investigations into each incident.

We found that people’s safety was not always maintained as we noted that a number of accidents had occurred when people in the home were being supported to move. Not all staff had current moving and handling training and fire safety training was still out of date. The temporary manager told us that they were aware of this and had arranged updated training.

We saw that two fire doors did not close properly during the inspection. We raised this with the temporary manager who agreed to ensure the maintenance team reviewed all fire doors immediately to ensure they would close in the event of a fire.

There were no concerns raised regarding staffing levels within the home.

We saw that the temporary manager had developed and implemented a new system to check the quality of the service and to improve communication within the staff team. Any issues identified by the temporary manager had been dealt with effectively.

Ratings from the last comprehensive inspection were displayed as required.

Our last inspection of the The Manor House was in September 2015 when we found that the service was good in all areas. This inspection was brought forward due to concerns that CQC had received. The inspection took place on 8 and 9 May 2017 and was unannounced on the first day.

The home is an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had been refurbished during 2015 and had en-suite toilet, wash basin, and shower.

The service is registered to provide accommodation and nursing or personal care for up to 59 people and 45 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff. The home also provided respite stays for people who lived in their own homes. The home is part of the range of services provided BUPA Care Homes.

The service had a registered manager, however we were informed that they had left their employment shortly before this inspection. 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.

One of the people living at the home told us “Some time ago it was very good. Now it is not.” Our findings during this inspection confirmed that the standard of care provided by the home had decreased since our last inspection.

We found breaches of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the home was not maintained to a safe standard and that regular checks had not been carried out to ensure that maintenance was up to date. For example we noted concerns with most radiator covers in the home and had to request that these were made safe.

The home was not compliant with the Mental Capacity Act (2005). Appropriate arrangements were not in place for people who were unable to safely consent to their care.

There was no manager working at the home and the home had lacked any clear and effective leadership for a period of time which had resulted in a decline in the service being provided.

Most of the day duty shifts were run by agency nurses who had limited knowledge of the people who lived at the home.

Staff were caring and were well thought of by people living in the home and their relatives.

There were regular activities in the home and people were happy with what was on offer and took part in and enjoyed them.

We were concerned during our last visit on the 9th October 2013 that there were three unexplained incidents of people's money or belongings going missing that had not been appropriately investigated or reported by the provider to identify or rule out the possibility of abuse. There were also no private facilities available for people to safely store personal belongings. We discussed this with the clinical services manager during our visit in October. We asked the provider to submit an action plan outlining what improvements would be made. During this visit we reviewed the action taken by the provider and found that sufficient progress had been made and compliance with the regulation now reached.

We saw that people who lived at the home and/or their relatives had been informed about the reported incidents of missing money or personal belongings, the incident reporting procedure and the options for safe storage of personal belongings and money at the home. The provider had also ensured that each person now had access to secure storage for their personal belongings.

We reviewed the records relating to the one incident of missing money reported since our last visit. We saw that the provider had undertaken an appropriate internal investigation and made appropriate referrals to the local safeguarding team, the Police and the Care Quality Commission in order to safeguard people against the possibility of abuse.

During our last visit in April 2013 we had minor concerns about the support for staff and record keeping at the home. An action plan was put in place with the improvements the home intended to make. Since we last visited, concerning information was also received about people/relatives involvement in their care; care and welfare of people living at the home; safeguarding, the administration of medicines and the equipment at the home. We looked at all these areas during this visit.

We spoke to five people and one relative. People/relatives were positive about the support received. People's records showed individual needs were assessed and views/preferences identified. There was evidence of regular,prompt access to health professionals when people's health declined and appropriate care for people with pressure sores. People's care records were stored securely in their own room.

We found equipment was well maintained, regularly checked and there was enough equipment to support people.

We reviewed medication arrangements and saw medicines were stored securely and administered safely.

Staff records showed appraisal and supervision of staff was undertaken and appropriate training provided.

We reviewed complaints/incident records. We saw three incidents where money/belongings had gone missing which had not been reported or fully investigated by the provider. This meant reasonable steps to identify or respond to the possibility of abuse had not been taken.

We spoke to three people who lived at the home and one relative. People told us the care was very good and they were well looked after. They said:

“Staff are lovely, they are excellent”

“Staff know me and they are good”

“The children have seen their mother here and they are very happy”.

We observed people were well cared for and treated kindly. We reviewed three care records and found people’s needs were assessed and reviewed. We found care records contained relevant information in relation to personal details, individual needs and preferences. Care plans and risk assessments were in place, individualised and up to date.

People were offered a balanced diet and a choice of menu options. People’s dietary requirements were assessed and adequate nutrition provided. On the basis of people’s feedback, a service improvement plan was in place to improve the quality of the food offered to people who lived at the home.

We reviewed three staff records. We found staff were not appropriately trained, supported and appraised to care for people.

The care records we looked at contained information that was either inconsistent or out of date in relation to people’s care. This meant that there could be a risk of people's needs not being met. Care records were seen to be left in corridors accessible to outside visitors to the home and staff not directly involved in the delivery of care. This posed a risk to people's confidentiality.

We spoke with four residents and a relative. They all told us the staff were always respectful and very helpful. One resident said “The staff treat me very well” and another said “I cannot fault the staff.”

People we spoke with said they could always talk to the manager if they had any concerns and these concerns were addressed promptly. Residents and relatives told us there were satisfaction surveys and residents' meetings available.

Residents told us their rooms were comfortable and regularly cleaned. They told us the food was usually good but they thought the menus had become repetitive. Three residents and two members of staff commented that although activities were available, they could be improved.

The inspection took place on 17 and 21 September 2015 and was unannounced on the first day. The home is an adapted grade 2 listed building set in its own grounds in a quiet residential area. There were a total of 58 bedrooms, all of which had recently been refurbished and had en-suite toilet, wash basin, and shower. On the ground floor there was a spacious lounge and dining room.

The service is registered to provide accommodation and nursing care for up to 59 people and 49 people were living there when we visited. The people accommodated were older people who required 24 hour support from staff. On the ground floor, care was provided for up to 13 people who had dementia and did not require nursing care. The home provided respite stays for people who lived in their own homes.

The home is part of the range of services provided BUPA Care Homes and had a manager who was registered with the Care Quality Commission. 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 we spoke with said they felt safe living at The Manor House. All staff had received training about safeguarding and issues that arose were reported and responded to appropriately. There were enough qualified and experienced staff to meet people’s needs and keep them safe. The required checks had been carried out when new staff were recruited.

The staff we spoke with had good knowledge of the support needs of the people who lived at the home and had attended relevant training. The staff we met had a cheerful and caring manner and they treated people with respect. Relatives we spoke with expressed their satisfaction with the care provided.

We found that the home was well-maintained and records we looked at showed that the required health and safety checks in relation to the premises were carried out. We found that medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

People we spoke with confirmed that they had choices in all aspects of daily living. They were happy with the standard of their meals and the social activities provided. People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at were comprehensive and gave details of people’s care needs and information about the person’s life and their preferences.

People we met during our visits told us that the home manager was very approachable. People were invited to complete satisfaction surveys sent out from head office and a programme of quality audits was in place to monitor the quality of the service.