We carried out a review of the data available to us about Manor Court Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Manor Court Home, you can give feedback on this service.
Manor Court Home is a care home providing accommodation with personal care for up to 24 people. The home is purpose-built accommodation, providing care and support to people across three floors. At the time of our inspection visit there were 18 people living at the home.
People’s experience of using this service and what we found
At our previous inspection we found risk management procedures needed to be improved to ensure people always received safe care. At this inspection the required improvements had been made. Risks to people’s health and wellbeing had been identified, assessed and managed. The provider’s checks helped ensure medicines management followed best practice. There were enough trained staff to provide safe care to people. The home was clean and people could visit their relatives when they wished. Staff understood their role in safeguarding people from the risk of abuse.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The registered manager was experienced and worked with the provider to develop and maintain systems and processes for reviewing the quality of the care provided. Any actions identified were pulled into a 'home improvement plan'. The provider worked with other organisations and healthcare professionals to improve outcomes for people.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published February 2020). We identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. The provider had submitted an action plan about how they intended to improve.
At this inspection we found improvements had been made and the provider was no longer in breach of regulations. At this inspection the overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
Why we inspected
The inspection was undertaken to assess whether the home had improved and whether the provider had met their action plan.
We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Manor Court Home is a care home, which provides accommodation and personal care for up to 24 older people, some of whom are living with health conditions or dementia. The home has four floors, and the ground floor has communal lounges, a dining area and conservatory. People had their own en-suite bedrooms. There is a large communal garden area. At the time of our inspection there were 20 people living at the home.
People’s experience of using this service and what we found
Most risks were well managed, and staff had risk management plans to refer to telling them how to reduce risks of harm or injury to people. However, some risks had not been identified and this posed risks of harm to people.
Staff did not always follow the training they had been given to ensure people’s skin was fully protected and this posed potential risks to people.
People had all their prescribed medicines available to them and were supported with these by staff trained in the safe handling of medicines. However, staff did not always follow manufacturer’s guidance in how medicines should be given through the skin.
The home had commenced a refurbishment plan which was much needed as some areas of the home were worn with damaged décor. The plan was to continue until all areas in need or refurbishment had been completed.
There were processes to audit the quality and safety of the service. Some issues had been identified as requiring improvements and were acted on. However, some audits, checks and oversight of staff still required improvement.
People told us they were happy living at Manor Court Care Home and described the home as having friendly staff and feeling safe living there.
People and relatives felt staff were kind and caring. Staff demonstrated a respectful approach toward people and gave support when needed.
There was a good level of cleanliness and actions had been taken to reduce risks of cross infection.
Checks were undertaken on staff to ensure their suitability to work at the home. Staff received an induction and training.
People had choices about drinks and what they ate for their main meals. Feedback about food was good.
Staff understood the importance of giving people choices. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People’s needs were assessed, and information was used to form plans of care.
There were enough staff on shift to meet people’s needs. Improvement had been made to staff’s shift patterns to ensure these met people’s needs.
There were systems were in place for people and relatives to give their feedback on the service. The provider’s complaints policy was displayed, and concerns were acted on.
Following our inspection feedback, the registered manager took some immediate actions to make improvements. This included mitigating risks and increased scrutiny of what checks and audits included.
We reported that the registered provider was in continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
These were:
Regulation 12 Regulated Activities Regulations 2014 – safe care and treatment
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rating for this service was Requires Improvement (published 28 November 2018).
Why we inspected
This was a planned inspection based on the rating of the last inspection.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.
Manor Court Home is a ‘residential care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 24 older people; living with physical frailty. Some people lived with dementia and / or other health conditions. At the time of our inspection visit 23 people lived at the home that has four floors.
The service is provided by Swinnerton Trust Limited, which was first established in 1951 to provide care and support for older people who live in the local area. The trust purchased the property, Manor Court Home, in 1952, refurbished it and converted it into a care home, to fulfil the aims of the charity.
A requirement of the services’ registration with us is that they have 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. A new manager had come into post during April 2018 and had become registered with us in September 2018.
At our previous inspection in January 2018, we found breaches in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. There had been no registered manager in post since October 2016. We found the Board of Trustees did not have sufficient knowledge of the Regulations to ensure compliance with the requirements of leadership and good governance. The assistant manager and staff were not supported by an appropriately skilled and experienced leader. We gave a rating of ‘Inadequate’ in well led and served the provider with a Warning Notice. The overall rating of the home was ‘Requires Improvement’.
At this inspection, we looked to see how the provider and new registered manager had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found that sufficient improvements had been made to meet the terms of the Warning Notice, further improvements were needed in the governance of the service and the oversight of staff practices. We found breaches in the regulations that related to the safety of the service. Further improvements were required in how the provider and registered manager assured themselves they were providing a safe service, that ensured people’s health and welfare needs were fully met. The rating continues to be ‘Requires Improvement.’ Further improvements were planned for in the number of staff on shift and updates in staff training. Plans to improve systems and processes to check and monitor the quality of the services provided were shared with us.
Since our last inspection, the newly appointed manager had become registered with us. The provider recognised that the trustees of the charity did not have the skills, knowledge or experience required to provide the support needed to the registered manager to make the required improvements and had appointed a business consultant. The provider’s business consultant had undertaken visits to the home and produced reports, with suggested actions, for the provider and registered manager.
Staff and people were positive about the newly appointed registered manger, who had introduced some systems and processes to monitor the quality of the service. However, these were not fully effective or embedded in every day practice. The registered manager shared their action plan with us, that included timescales, for further improvements to be made to the services provided. For example, staff were to undertake updates in training in all aspects of care practices between October 2018 and January 2019.
Most people felt safe living at Manor Court Home because it was secure and staff were on hand to support them. However, there was not always sufficient staff on shift to meet people’s individual care and support needs. Care staff did not always have time to support people’s emotional needs or offer activities for people to engage in. People’s care needs were not consistently responded to by staff in line with people’s care plan guidance, or delivered to people when they wanted it.
Safeguarding concerns had been reported to the local authority as required. Processes had been introduced for managing accidents and incidents that occurred.
Risk management plans were available and told staff what actions they should take to reduce risks of harm or injury to people. There was a lack of managerial oversight in checking important day to day records, and associated actions, were being undertaken by staff.
Improvements had been implemented to systems of safe staff recruitment. Staff felt supported in their job role, though had not received all the training they needed to give them the skills and knowledge they needed to provide effective care. Most refresher training was overdue, but some sessions were planned for to address this.
Overall, people were offered and supported to eat a balanced diet and drink enough to maintain their wellbeing. However, records of people identified ‘at risk’ of not eating or drinking enough did not contain sufficient detail to show their needs were always met.
People were supported to access healthcare professionals to maintain and promote their health. People had their prescribed medicines available to them. However, people’s medicines were not consistently handled or administered to them in a safe way in line with best practices. Medicine management checks had not always identified where improvements were needed.
Staff worked within the principles of the Mental Capacity Act 2005 and gained people’s consent to care before supporting them. Managers understood their responsibilities under the Deprivation of Liberty Safeguards.
Most people were positive about their experience of living at Manor Court Home and told us, overall, staff were kind and caring toward them. However, some people and relatives did not feel able to raise concerns they had with staff or, if they had, did not feel their concerns were fully resolved.
We found a breaches of the Health and Social Care Regulations. You can see what action we told the provider to take at the back of the full version of the report.
Since our previous inspection in February 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.
The service is provided by a charitable trust, Swinnerton Trust Ltd, which was first established in 1951 to provide support for older people who live in the local area. The Trust purchased the property, Manor Court Home, in 1952, refurbished it and converted it into a care home, to fulfil the aims of the charity.
The Chairman of the Board of Trustees had been appointed in 2014, but was not appointed as the Nominated Individual’ (NI) or representative for the provider, at the time of our previous inspection. In October 2017, since our previous inspection, the Chairman had been appointed as the Nominated Individual, that is, the person we communicate with about the service. During our inspection, the Chairman represented the Board of Trustees. We refer to the Chairman as ‘the provider’ in our report, but legal responsibility for the service is shared jointly by the whole Board of Trustees.
At the last inspection in February 2016, the service was rated Good. At this inspection we found improvements were required in the management, leadership and governance of the service, which also had an impact on the safety and responsiveness of the service and the overall rating.
There was not 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 previous registered manager had left the service in September 2016. The provider had appointed the deputy manager as the manager, and relied on the manager to take over the responsibilities of a registered manager. The provider had invited the deputy manager to apply to become the registered manager, but they had not successfully submitted an application to become registered. We refer to the deputy who was managing the service as ‘the manager’ throughout our report. Because there is no registered manager at the service, all oversights and omissions are the responsibility of the provider that is, the Board of Trustees
The provider did not demonstrate knowledge of the Health and Social Care Act Regulations 2008, but had relied on the manager to know how the Regulations applied to the service. The provider had not given the manager sufficient access to training in the requirements of being a registered person. The provider had not given the manager sufficient support, guidance or mentoring to equip them for the role of a registered manager. During our inspection visit, the manager told us they had decided not to apply to be the registered manager. They said they felt they needed more time to acquire sufficient knowledge and skills to be confident to be legally responsible for the service.
None of the Trustees of the Board had stepped in to guide, mentor or support the support the manager to understand the requirements of the delivering a registered service in accordance with the Regulations. They had not provided effective leadership for a service of this type. The systems and processes necessary to ensure good governance had not been established or operated effectively to enable improvements to the quality of the service.
Staff and the manager responded to and resolved complaints when they were raised, but there was not an effective system for recording, analysing and learning from complaints.
Improvements were required in analysing information about people’s abilities and dependencies to ensure staffing levels were reviewed and revised in line with increases in people’s needs.
Improvements were required in analysing information about accidents, incidents and falls, to ensure any risks related to the premises, staffing or staff’s skills were minimised. Improvements were required in the guidance for the manager to ensure staff recruitment was consistent in making all the necessary checks in line with best practice.
Medicines were stored, administered and managed safely, but improvements were required in the guidance for staff to ensure they followed best practice in recording when and where creams and pain relief patches were applied to people’s skin.
Work to minimise the risks related to fire safety was in progress at the time of our inspection visit. The local fire protection officer had revisited the service to check the provider was acting on their recommendations.
The provider minimised risks related to the premises and equipment through servicing agreements and regular checks by qualified professionals.
People were protected from the risks of abuse because staff were trained in recognising and reporting any safeguarding concerns. Risks to people's individual health and wellbeing were identified with the person and their representative and care was planned to minimise the identified risks.
People were cared for and supported by staff who had the skills and training to meet their needs effectively. People were supported to eat and drink enough to maintain a balanced diet that met their preferences.
People were supported to see healthcare professionals for routine appointments or when a change in their health was identified. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff were thoughtful, kind and polite and had a positive attitude to their work and spoke with enthusiasm about caring for people. The manager and staff understood people's diverse needs and interests and encouraged them to maintain their independence according to their wishes and abilities. Staff respected people's right to privacy and supported people to maintain their dignity.
Staff were happy working at the home because they had confidence in their colleague’s skills and worked as a team.
Further information is in the detailed findings below.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Manor Court is a residential care home providing accommodation for up to 23 people who require personal care. The home has three floors and access to a large and well maintained garden. All of the rooms had ensuite facilities and all floors had access to a lift and stair lifts. At the time of our inspection visit there were 22 people living at the home and there was one vacancy.
Manor Court Care Home had 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.
People told us they liked living at Manor Court and felt safe. Peoples’ care had been planned and agreed with them. Risks were managed well and there were clear care plans drawn up to keep people safe, while at the same time optimising their independence.
Staff had a good understanding of safeguarding, could describe what abuse was and knew the reporting systems if any allegations of abuse were raised. There were sufficient numbers of staff to ensure safe care and support. Staff recruitment processes ensured staff were suitable and safe to work in the home. People received their medicines safely.
Manor Court was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). We saw people were encouraged and supported to be independent.
Staff knew people well and supported people in accordance with their individual preferences and needs. Staff received the training and support they needed to carry out their roles.
Peoples’ privacy and dignity was respected and maintained. People highly commended staff and commented on their compassion and motivation. We saw people were supported and cared for by kind and respectful staff.
Each person’s needs were assessed and this included obtaining a detailed life history of people. Care plans showed how peoples’ needs were to be met and how staff should support people. Care and support was tailored to each person and reflected peoples’ preferences. People were supported by staff to access healthcare services as and when needed.
Staff supported people to engage with stimulating and interesting activities of their choice.
People had the nutrition they needed to maintain their health and wellbeing. People said they had an “excellent” choice of food and drink available. The provider consulted people about the food and meal choices. People’s nutritional needs were assessed and monitored.
People and staff told us the home was well- led and we saw satisfaction surveys and monthly meetings ensured peoples’ views were heard. There were a range of audits in place which checked the effectiveness, safety and quality of the service which the provider used to make any improvements.