We carried out an unannounced comprehensive inspection on 30 October 2017 and 01 November 2017.

The Manor Nursing and Residential Home is a care home with nursing. It also specialises in end of life care. The service is registered to provide accommodation for nursing and personal care for up to 22 older people. On the days of our inspection there were 19 people living at the care home.

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.

People lived in a service with exceptional leadership. The providers caring values were embedded into the culture and staff practice. People, relatives, external professionals and staff spoke positively about the management of the service. The registered manager had a committed and passionate attitude about the service, the staff, but most of all the people. Staff spoke of their love for the people they cared for, and their passion for working at the service.

People were treated with kindness and endearing compassion by staff who truly respected and valued them. Staff offered exceptional and distinctive care and support to people. People’s emotional needs and support were compassionately recognised. Staff displayed the upmost empathic and compassionate behaviour. People were supported and given time to express their views so that those caring for them fully understood their wishes and preferences.

People lived in a service which was monitored by the provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

The provider and registered manager were open, transparent and admitted when things had gone wrong. This demonstrated their understanding and recognition of the Duty of Candour. The Duty of Candour means that a service must act in an open and transparent way in relation to care and treatment provided when things go wrong. The provider notified the Commission of significant events which had occurred in line with their legal obligations. For example, regarding safeguarding concerns, deaths and serious injuries.

People’s family and friends were warmly welcomed. When people did not have a family, or anyone to act on their behalf, advocacy services were appointed. People’s comments and complaints were viewed positively and used to help improve the quality of the service.

People received personalised care. People’s individual equality and diversity was respected, enabling people to be supported in the way they wanted to be. People’s care plans were person-centred. They detailed how they wanted their needs to be met in line with their wishes and preferences, taking account of their social and medical history, as well as their cultural, religious and spiritual needs. People’s communication needs were effectively assessed and met and staff told us how they adapted their approach to help ensure people received individualised support.

People received an organised and co-ordinated approach to their health and social care needs. People had access to external healthcare professionals to ensure their ongoing health and wellbeing. People’s care records detailed a variety of professionals were involved in their care and people were actively involved in monitoring their own healthcare.

People were supported at the end of their life to have a comfortable, pain free and dignified death by staff who were loving, and had received accredited palliative care training. The service was accredited with the local hospice. The staff worked collaboratively with external professionals, ensuring people re

We spoke with 15 of the 18 people who were resident at the home on the day of the inspection. We also spoke with some people’s relatives and three of the staff.

Most of the people we spoke with were happy with the care they received at the home. Comments included “the care here is brilliant, I have a nice room and the staff are caring,” and “the staff are delightful.” Some people said there could be improvements to the staffing levels, the food and planned activities. A small group of people said they had concerns about a minority of staff attitudes.

Accommodation was furnished, decorated and maintained to a good standard. The home was very clean and odour free. Health and safety standards were satisfactory. There was evidence of a quality assurance systems in place.

This inspection took place on the 20 and 23 July 2015, and the first day was unannounced.

The Manor Nursing and Residential Home is a care home with nursing, situated in the village of Yealmpton. The home is registered to provide accommodation for nursing and personal care for up to 22 older people: 18 people were living at the home at the time of our inspection.

The service had 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.

People told us they felt safe in the home, comments included “yes I feel safe here.” The relatives we spoke with confirmed their confidence that their loved ones were safe. Staff had received training in safeguarding vulnerable adults and had a good understanding of how to keep people safe.

Risks to people’s safety and well-being had been assessed prior to their admission to the home, regularly reviewed and were well managed. Advice was sought when necessary from health care specialists, such as dieticians or the community mental health team. People’s medication was managed safely. People had prompt access to their GP, or other specialists such as occupational or physiotherapists, when needed and the outcomes of these referrals were recorded in people’s care files. One community nurse told us the care at the home was very good, and they and their colleagues had no concerns over the ability of the staff to care for the people living at the home..

People spoke highly of the care they received. They told us the staff were always caring and friendly: comments included “they are such kind girls”, “I’m very happy here, I’m well looked after” and “the staff are very nice.” For those people who were unable to share their experiences of living in the home, we saw during our periods of observation, people were treated kindly and with patience. Relatives told us they were happy with the care their loved ones received, one relative said “(name) loves it here, they get on really well with the staff” and another said “she’s very well cared for.”

People were supported by sufficient numbers of safely recruited and well trained staff. The registered manager confirmed staffing levels were arranged in accordance with people’s care needs which were regularly assessed in consultation with the staff. People told us there were enough staff on duty to support them. One person told us “yes, there seems to be enough staff”. We saw people being assisted unhurriedly and call bells were answered promptly. People told us they had confidence in the staff and spoke positively about the care they received. Staff were knowledgeable about people’s care needs and had the skills and knowledge to support them. Staff received regular supervision and appraisal of their work performance as well as their training and development needs. Staff told us they enjoyed working at the home, they said “I love working here”, “there is a great deal of satisfaction from caring for people” and “I’m proud of the care we give.”

People and their relatives where appropriate, were involved in planning their care. The care plans recorded what people were able to do for themselves, their preferences in how they wished to be supported and provided staff with clear guidance. The home uses a “key worker” system, where people have a named carer responsible for reviewing their care and support needs, arranging appointments and ensuring people have items such as toiletries, or any equipment they need.

People’s wishes regarding how and where they wished to be cared for at the end of their lives was described in the care plans. The home had received training and guidance from the local hospice in providing end of life care and had it’s practice acknowledged by the hospice as providing a high level of care to people: the registered manager and one of the nurses were “End of Life Champions.” Between the two days of our inspection, the home had held a meeting to encourage people and their families to think about how they wished to be cared for at the end of their lives and if there was anything they wished to achieve before they died.

Staff had a varied understanding of the Mental Capacity Act 2005, (MCA) some staff understood the principle that people were presumed to have the capacity to make decisions, while others weren’t sure. We discussed this with the registered manager and they agreed to provide additional training and information for staff.

People told us they liked the food and had a good choice available to them. Comments included, “I love the food” and “the food is excellent and nutritious.” We saw people enjoying their lunchtime meal: people were offered choices and the mealtime was pleasant and unhurried. We saw people were supported to eat in a manner that respected their dignity and at an appropriate pace.

The results of the recent quality assurance survey (May 2015) showed people identified “more activities” as an area for improvement. The registered manager said this was a priority and confirmed the registered provider had recently increased the leisure budget to enable this to happen. One staff member took the lead in planning activities but the staff said they were all involved in providing activities at some time during the day, usually in the afternoons. A “Wishing Tree” meeting had identified people’s wishes in relation to activities they would like to take part in and staff used this to plan events.

People and their relatives as well as the staff told us the home was well managed. There was a policy in place for dealing with any concerns or complaints and this was made available to people and their families in the entrance hallway. People said they would speak with the registered manager, or any of the staff, if they had any concerns or wanted to make a complaint, but they had not needed to do. The registered manager said they had an “open door” policy for people, their relatives and staff to discuss any issues of concern or to make suggestions about improvements in the home. The registered manager was a member of the “Outstanding Manager’s Group” run by a training provider in association with Skills for Care, (the employer-led workforce development body for adult social care in England). This management group shares good practice and keeps abreast of new initiatives in caring for older people.

The registered manager used a number of methods to gain people’s, relatives’ and staff’s views of the care and support provided at the home, including individual and group meetings and using surveys. The results of the survey in May 2015 showed a high level of satisfaction with the way the home was managed. In response to the question about making improvements to the home, the comments received included, “I wouldn’t change anything” and “everything is satisfactory.”

The registered provider met regularly with the registered manager and records of these meetings were made available. We saw actions had been identified and met, and included providing equipment people needed such as new beds or air mattresses, and making improvements to the environment. For example, one person had requested the doorway from the conservatory to the patio be levelled so they could access the patio without the assistance of staff, and we saw this had been done.

Health and safety audits ensured medication practices were safe, equipment was safely maintained and accidents reviewed to identify any trends and prevent them re-occurring.