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Inspection carried out on 25 September 2017

During a routine inspection

The inspection took place on 25 and 29 September 2017 and was unannounced on the first day.

Manor Court is a residential service providing care without nursing. Nursing services are provided by the community nursing teams. Residential care is provided for up to 37 older people, some living with dementia. On the day we inspected, 36 people were living at the service. High quality accommodation and facilities were provided. Each person had their own room with a kitchenette and ensuite bathroom facilities.

At the last inspection in June 2015, the service was rated Good. At this inspection we found under the leadership of a new registered manager the service had continued to develop and improve and we have rated the well-led and caring section as Outstanding.

The service had a new 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 service was exceptionally well-led. The registered manager led a visible, committed, caring team to provide excellent, holistic care. There was a focus on continuous improvement to enhance people’s lives. New research initiatives in dementia care were being continually implemented for the benefit of people for example programmes such as Anchor Inspires, Oomph! and the Archie Project. These supported people to remain mentally and physically active.

People, relatives and professionals described the provider and management team in a particularly positive way. During the inspection, people and staff were relaxed, and there was a calm, quiet atmosphere. We observed staff chatting with people and making them feel special. Everybody had a clear role within the service.

People’s voices were listened to and ideas implemented for example a special black tie evening had been held with old style card games for the gentlemen. Staff were confident to speak out and ask for anything they needed to deliver high quality care for example additional training or new equipment. We were told the registered manager, deputy and staff were a role model to others. This had led to a change in culture at the service over the past 12 months. Everyone we spoke with told us the leadership team were supportive and approachable. This had resulted in high staff morale and high satisfaction amongst people and families. Staff talked positively about their jobs and their love of the people living in the home. All staff we spoke with were proud of the excellent care people received. Staff told us it met the “Mum Test.” The provider’s district manager supported the service and registered managers.

Feedback we received about end of life care was exceptional. Countless letters from families described how compassionate staff supported people and their families throughout the whole process. Families were able to stay at the service during someone’s last days and staff did all they could to meet people’s final wishes.

Staff exhibited an exceptionally kind and compassionate attitude towards people. Staff were mindful of equality and diversity and respected people. Positive, caring relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity and individual behaviours. Feedback we received from people, relatives and professionals was excellent.

People’s risks were managed well and monitored. Positive risk taking was encouraged to support people’s independence. The environment supported people living with dementia with spacious lounges, visual stimulation and dementia friendly lifts. People were promoted and encouraged to live full and active lives and we observed many enjoy an exercise session. An old styl

Inspection carried out on 24 and 26 June 2015

During a routine inspection

The inspection took place on the 24 and 26 June 2015 and was unannounced.

We last inspected the service on the 2 May 2013 and found no concerns.

Manor Court is a residential service offering care without nursing. Nursing services are provided by the community nursing team. The service is registered to accommodate a maximum of 37 older people who may be living with dementia. On the day we visited there were 33 people living at the service. However, two people were in hospital.

There was 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.

The recordings required to support staff to provide appropriate care were inconsistent in evidencing they were up to date and reflective of people’s current needs. This meant staff did not have the information available to them to ensure they were delivering care appropriately and as desired by people. The registered manager had identified this as an issue and work had commenced on addressing this.

People’s risk assessments and care plans were not up to date nor demonstrated they had been regularly reviewed. The registered manager had recognised this and started to address the concerns. Staff were knowledgeable about the risks people faced and how to keep them safe.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. Everyone had a capacity assessment in place in relation to their ability to consent to being cared for by staff at Manor Court. However, records did not evidence people were assessed to make certain decisions, at a certain time. Records also did not show a best interest decision was made involving people who knew the person well and other professionals, where relevant. The registered manager had identified this and had begun to address the concerns. People were always asked for their consent before staff commenced care.

When we spoke with staff they were well informed of people’s care needs and how people’s care should be delivered. Staff treated people with kindness, respect and patience. People told us their dignity was always respected. People’s medicines were administered safely. Staff followed clear infection control policies.

People felt safe living at Manor Court and told us they felt comfortable talking to staff about any concerns. There was sufficient appropriately trained and supervised staff to meet people’s needs safely. All staff regardless of their role were trained to meet the needs of people living with dementia. The service was recently awarded the Dementia Kite Mark by the local authority. This demonstrated they had reached an accredited standard of meeting the needs of people living with dementia. Staff were recruited safely and understood how to identify abuse and keep people safe from harm. Everyone felt the registered manager would act on any concerns raised.

People had their nutritional and health care needs met. People were positive about the quality of the food. People’s special dietary needs were catered for and staff were flexible about catering for people’s desires, likes and dislikes. People could see their GP and other health care professionals as required.

The service had policies and practices in place to underpin the running of the service. There was a complaints policy which was available to all people and visitors. People’s concerns and complaints were investigated and only closed when people were happy with the result.

Activities were provided on a group and individual basis to keep people mentally and physically stimulated. People’s faith and cultural needs were met.

There were clear systems of national and local governance in place. People, visitors and staff were involved in reviewing the service. The provider and registered manager had audits in place to ensure the quality of the service. Where concerns were found an action plan was developed with regular review to ensure the issues identified were put right. For example, a recent care plan audit identified concerns about the quality of the care plans and an action plan had been developed to address this. This was being overseen by senior managers from the provider.

Inspection carried out on 7 May 2013

During a routine inspection

We met seventeen people who used services, spoke to ten relatives, two visiting professionals, talked with the staff on duty and checked the provider's records. We also spoke to the newly appointed unregistered manager. One person using the service said, “We see the (unregistered) manager every morning”. We looked at surveys sent out and returned to the home for further information.

We saw people’s privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. One relative said, “The staff have been so helpful".

Staff were clear about the actions they would take should they have any concerns about people's safety.

We looked at care records for three people. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them. Both visiting health professionals we spoke with confirmed that the staff at the home were helpful by assisting them with people.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine if they were able to make particular decisions about there lives.

As part of the quality monitoring system, people who lived in Manor Court were sent surveys to complete. These surveys asked their views of the home to show that peoples view were important to Anchor Care.

Inspection carried out on 9, 10 October 2012

During an inspection in response to concerns

Over the two day visits to Manor Court we spoke with people living at the home, relatives, staff members, a professional and the homes unregistered care manager .We looked at six people’s care files.

We saw that staff did not always treat people with respect and people were left for long periods without any interaction.

One person living in the home told us that they had to wait so long for a call bell response from staff that they were incontinent which caused them great upset and embarrassment.

We saw people’s food and fluid charts not being completed, even after a reminder by us, on the first day of our visit. Urine output charts were not completed as requested.

Care plans were not completed or updated and did not reflect people health and social care needs. This means that people’s care needs may not have been met.

We found that some of the care plans had not been signed by the person concerned even though they had capacity to do so. This means the person receiving care has not agreed to their plan of care.

One person said the home had, “Not enough staff”. One staff said, “We never have time to talk to people” and there was “No management support”.

We had received concerning information about people’s needs not being met in a timely way possibly due to low staffing levels. During our visit we saw this appeared to be the case, the home did not currently have a manager in place taking charge of the home and monitoring staffing levels.

Inspection carried out on 1 December 2011

During a routine inspection

On the day of our visit the care manager (deputy manager) was on duty at the home and they showed us around the home and answered any questions we had.

People that we spoke with confirmed that staff always treated them with respect. We heard staff speaking with people in a kindly, friendly way.

Two of the people we spoke with knew they had care plans, one was not interested in them and the other said they had been consulted about theirs. People living at the home told us that the doctors and district nurses that visited were very good.

People told us that they liked living at the home because "I can still have a modicum of independence" and "It affords me the help I need". People also told us that the food was "sometimes good and sometimes not so good" and another said it was, "alright - not anything special, but the homemade pasties today were very nice".

People living at the home praised staff and told us, "staff care for me well", "staff are very good" and "(I) can't knock staff for anything, they are always polite and helpful".