The Manor House - Frenchay

Updated 13 March 2019

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 provide a rating for the service under the Care Act 2014.

The inspection was carried out by one adult social care inspector, who visited on 08 and 09 January 2019. We last visited the service in June 2016 and found no breaches of regulations.

We used a variety of methods to obtain feedback from those with knowledge and experience of the service.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they planned to make.

We reviewed the information included in the PIR along with information we held about the service. This included notifications, which is information about important events which the service is required to send us by law.

We contacted the local community learning disability team and commissioners. We asked them for some feedback about the service. You can see what they told us in the main body of the report.

During the inspection, we talked with four people using the service, a relative, five members of staff, the provider and the registered manager. Four members of staff contacted us via email to tell us about their experiences and spoke with five relatives on the telephone.

We looked at the care records of two people, staff duty rotas and other records relating to the management of the service. These included three staff recruitment files, maintenance records, incident reports, training records and audits.

Updated 13 March 2019

This inspection took place on 8 and 10 January 2019 and was unannounced.

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.

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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The values that underpin Registering the Right Support and other best practice guidance were seen in practice at this service. There was overwhelming evidence that the core values of choice, promotion of independence and community inclusion; were at the centre of people's day to day support. Staff were extremely person centred in their approach in supporting people with their day to day goals and their long-term aspirations.

However, the service was a large manor house, which was larger than most domestic style properties and was registered to support up to 23 people. There were 16 people living permanently in the service and seven people living at the service for short breaks. This service is larger than current best practice guidance. The registered manager and provider had reduced the negative impact on people in the following ways. The design of the building was such that it fits into its environment, as it was in a residential road with other large domestic homes of a similar size.

The home had been divided into three separate units, Chestnuts, Arandell and Beechwood supporting people in smaller groups of six and eight. Each unit had their own communal space consisting of a lounge, kitchenette and dining facilities and bathrooms. There were also additional shared areas which people could use to their benefit, such as an arts and crafts room, a central lounge and a sensory room, large gardens including a sensory garden. In addition to their very personalised bedrooms.

Staff were allocated to each unit enabling them to support people in a very person-centred way. People had a high level of autonomy over how they spent their time. People's support was built around them and this enabled people to live individualised lifestyles. There was a calm welcoming atmosphere in the home. It did not feel overly busy or institutionalised.

People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse. Staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment and fire systems.

People received extremely effective care because staff had the skills and knowledge required to support them in a very person centred way. People's healthcare needs were monitored by the staff. The service was commended by health care professionals on their person centred approach. Staff knew people very well and noticed slight changes in people which might indicate that they were not well or unhappy.

People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected. This had been fully embedded into practice.

Staff recognised the importance of effective communication enabling them to respond to people in a person-centred way. People were very much involved, they were consulted about activities and their goals and aspirations kept under review and met. Meaning people led very individualised and active lifestyles.

The home continued to provide an extremely caring service to people. People, or their representatives, were involved in decisions about the care and support they received. Staff were knowledgeable about the people they supported. There were strong links with family. There was a strong culture to provide care that was tailored to the person. People were treated with kindness and compassion.

People received an exceptionally responsive service. Care and support was personalised and very much led by the person. There was a ‘can do’ attitude. People’s care was planned and delivered in a way that meant the person was at the forefront. Activities were extremely varied and people were not discriminated against because of their learning or physical disability.

The service was well-led. Relatives and staff spoke extremely positively about the commitment of the registered manager and the team in supporting people. There was a commitment to providing a service to the wider community with social opportunities being organised. There was a passion throughout that enabled people to live the life they wanted, very much driven by the registered manager, which had been cascaded to the whole team.

The registered manager and provider had monitoring systems, which enabled them to identify good practices and areas of improvement. It was evident they strived to provide the best experience for people and were creative in their approach.