We carried out an unannounced inspection of The Manse on 16 October 2018. The Manse is a care home which provides care and support for up to 23 predominantly older people. At the time of this inspection there were 23 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is on two floors with access to the upper floors via stairs or chair lifts. All rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges, a conservatory, a dining room with seating areas, garden and patio seating at the side of the service.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 atmosphere in the service on the day of the inspection was relaxed, friendly and calm. Staff responded promptly when people asked for assistance and support was provided at a relaxed pace. Throughout our inspection we observed staff providing support with respect and kindness.

People’s risks were being managed effectively to ensure they were safe. Records showed where changes in people’s level of risk were. Care plans had been updated so staff knew how to manage those risks.

People received care and support that was responsive to their needs because staff had the information to support them. Staff supported people to access healthcare services. These included, social workers, psychiatrists, GP’s and speech and language therapists (SALT).

People who used the service and their representatives were positive about the care they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people's choices and privacy and responded to requests for assistance. People and their representatives told us they felt safe when receiving care. People were involved in developing and reviewing their care plans.

Medicines were stored safely in the home and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse.

The manager used effective systems to record and report on accidents and incidents, acted when required and reflected on incidents to mitigate risks.

Staff were sufficiently skilled to meet people’s needs. Necessary pre-employment checks had been completed and there were systems in place to provide new staff with appropriate induction training. Existing staff received regular training, supervision and annual performance appraisals.

There was a system in place for receiving and investigating complaints.

People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

Auditing procedures took account of all areas of operation within the service to ensure systems were effective.

We inspected The Manse on 11 April 2016, the inspection was unannounced. The service was last inspected in August 2014; we had no concerns at that time.

The Manse is a family run residential home that can accommodate up to 23 older people. On the day of our inspection 21 people were living at the service. The Manse is required to have a registered manager and there was one 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.

Care plans contained risk assessments which identified when people were at risk, for example from falls. Guidance for staff contained detailed information on the action staff could take to minimise the risk.

Medicine Administration Records (MAR) were clear and accurate. This showed how much medicine people were receiving and whether the amount of medicine in stock tallied with the amounts recorded.

The registered manager had oversight of the service and people, relatives and staff told us they were available and approachable. Management was supported by a head of care and an effective staff team. In addition the staff team included kitchen staff, cleaning staff and a maintenance worker. There were clear lines of accountability and responsibility. There were sufficient numbers of staff to meet people's needs.

People and relatives told us they considered The Manse to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service in terms of its 'family' feel. Terms such as 'homely' and 'friendly' were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

Pre-employment checks such as disclosure and barring service (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a wide range of training available to help ensure staff were able to meet people's needs.

Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made to the local authority appropriately. Training for the MCA and DoLS was included in the induction process and in the list of training requiring updating regularly. The registered manager and staff demonstrated an understanding of the principles underpinning the legislation. For example, staff ensured people consented before giving personal care. Mental capacity assessments had been completed as required.

The premises were clean and odour free. People were able to use two shared lounges or stay in their rooms as they chose. Improvements to parts of the building were planned. There was a garden available for people to use when the weather was suitable. Staff told us this was well used.

There were two part-time activity co-ordinators employed and people were supported and encouraged to take part in a range of activities organised in the service. There were also trips and activities planned outside the service. Visitors were made to feel welcome at the service and staff recognised the value of these relationships to people.

This inspection was carried by one inspector over one day to follow-up on identified non-compliance with Regulation 18 of the Health and Social Care Act 2008; which concerns appropriate consent to care and treatment. We will consider the question of the effectiveness of the service in relation to this area.

Is the service effective?

At the time of our inspection we found the service to be effective.

During our last inspection on 27 June 2014, we identified a number of instances where the provider had not followed their policy and procedure in relation to ensuring people who lived at The Manse, were adequately consulted and recorded as having given their consent to the care planning process undertaken by The Manse. The registered manager told us it had not always been possible for people to physically sign their care plan documents or to meet with relatives to gather their input and/or signature.

During the previous inspection, concerns were raised about the appropriate policy and procedure for recording people’s' preferences as regards individuals’ decisions about future resuscitation, should this be required.

During this follow-up inspection we were assured by the registered manager that steps had been put in place to improve the system in this area. The Manse had implemented new procedures and updated their policies regarding consent. On the day of inspection The Manse were operating effectively in this area.

This inspection was carried by one inspector over one day. During the inspection, the inspector worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

Yes, at the time of this inspection we judged the service was safe.

People we spoke with were positive about the staff who worked at The Manse. People told us staff were professional and supportive. For example, one person said “ staff are very nice, they are very good.” A relative of a person who lived at the Manse told us, “All of the staff have been excellent with X. They are patient and kind”

We spoke with professionals who visited the home on the day of inspection. People told us, “This is one of the better services of this type that I visit. There is a good culture. It always seems friendly and a happy place”.

The service had a well organised medication system. The system was well managed and regularly audited. Records were accurate and up to date.

Is the service effective?

At the time of this inspection we judged the service was not fully effective.

People all had individual care planning records, which set out their care and support needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their relatives’ needs and responded promptly when they needed assistance. People told us and we saw in people’s’ records, that they had access to doctors, community psychiatric nurses, psychiatrists, chiropodists and opticians.

However, we found the issue of ensuring appropriate consent was not following the home’s own policy guidance concerning the Mental Capacity Act (2005) or local guidance.

Is the service caring?

Yes, at the time of this inspection, we judged the service was caring.

Relatives of people who used the service, and external professionals such as GPs and district nurses said they were happy with how the service supported people and found the staff to be professional and helpful. A relative told us “it is very good. I have no concerns.”

From our conversations with people who had experience of the service and a review of the records we assessed, we judged that individual wishes and needs were taken into account and respected.

Is the service responsive?

Yes, at the time of this inspection, we judged the service was responsive.

Everyone we spoke with said the staff treated people with respect and dignity. People told us and we saw from records that people were able to be involved in activities including exercise classes, visits from a hairdressing service and sessions at the home with a local musician. From our conversations with relatives, and management, staff and other professionals we formed the view that the service were diligent about ensuring they could meet the changing social and support needs of each person supported.

Is the service well-led?

Yes, at the time of this inspection, we judged the service was well led.

Staff, relatives and external professionals were all positive about the management of the service. People told us management would listen to staff and also to any concerns raised by people who lived at The Manse and/or their relatives and were supportive.

The Manse had a system to check people were happy with the service. This included systems of survey and audit. There was also a system to monitor accidents and incidents. People’s personal care records, and other records kept in the home, were accurate and complete.

People who used the service told us they were comfortable and we saw people relaxing in the lounge. The staff we spoke with told us they would have no hesitation in raising concerns if the need ever arose.

This service was inspected in April 2013, and this inspection was in response to improvements identified as need at that time. People who used the service were protected from the risk of abuse, because staff were aware of the safeguarding process and had received training in this.

People who used the service told us they were comfortable and happy living in the home. Two visitors to the home told us their relative was "looked after well". We saw people socialising with other people using the service, watching TV and singing along together. Two visitors told us they would have no hesitation in raising concerns if the need ever arose.

We saw privacy and dignity were respected during our visit, and we saw staff offering discreet help to people. Staff talked to people while offering them assistance. We saw people’s wishes were respected. We observed people moving around the home without restriction, and where there were restrictions this had been properly documented and referred to other relevant agencies, for advice.

We found people’s privacy, dignity and independence were respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were not always protected from the risk of abuse, because staff were not confident in their knowledge of the safeguarding process.

People were protected from the risk of infection because appropriate guidance had been followed.

We found staff had started to receive appropriate professional development and accurate and appropriate records were maintained.

People who used the service told us they were very comfortable and happy living in the home, and the home was well maintained and kept very clean. They told us they chose what they did each day, and there were activities they could join in if they wished. We saw people socialising with other people using the service, watching TV and listening to music. People told us they could raise concerns to staff or the manager if the need ever arose.

We saw privacy and dignity were mostly respected during our visit, although two people said “not all the staff knocked before entering”. Staff talked to people and offered them assistance. We saw that people’s wishes were respected. We observed people moving around the home without restriction.

We found people’s privacy, dignity and independence were respected and people’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

People experienced care, treatment and support that met their needs and protected their rights.

People who used the service were not always protected from the risk of abuse, and people were not always protected from the risk of infection because appropriate guidance had not been followed.

We found staff had not received appropriate professional development and accurate and appropriate records were not maintained.