Manor Court Care Home

Manor Court Care Home is a care home that provides personal and nursing care for up to 111 people accommodated in four self-contained units. At the time of our inspection, only three of the units were in use accommodating 78 people. The service provides care to older people, some who were living with the experience of dementia, and younger adults with physical disabilities.

People’s experience of using this service and what we found

The provider did not always have effective systems in place to protect people from risks they faced in their daily lives. We found there were not enough staff to meet people’s needs and to provide safe care. We observed staff were task focused and did not always have time for much meaningful interaction with people. There was also a lack of person-centred activities.

The provider had infection prevention and control policies in place, but records showed cleaning schedules were not always completed and we identified several areas where cleaning had not been maintained adequately.

The provider had systems in place to monitor, manage and improve service delivery, but these have not always been used effectively so shortfalls were identified in a timely manner and addressed.

Safe recruitment procedures were followed. Staff knew how to respond to possible safeguarding concerns. We saw medicines were managed safely so people received their medicines as prescribed.

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.

Care plans were personalised and recorded people's preferences, so staff knew how to respond to people's needs appropriately.

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 good (published 25 November 2021).

Why we inspected

We received information of concerns in relation to staffing levels and the impact this had on the quality of care people were receiving. As a result, we undertook a focused inspection to review the key questions of safe, responsive 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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches of regulations in relation to safe care, person centred care, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manor Court is a residential care home that provides personal and nursing care for up to 111 people accommodated in four self contained units. At the time of our inspection, only three of the units were in use accommodating 83 people. This included older people, some who were living with the experience of dementia, and younger adults with physical disabilities.

People’s experience of using this service and what we found

During the inspection we found the provider had systems and processes in place to help keep people safe including risk assessments and risk management plans. Medicines were generally managed safely. People and relatives told us they thought people were safe. Safe recruitment procedures were in place.

The provider had systems in place to manage infection prevention and control. Staff generally wore personal protective equipment (PPE) appropriately and visiting was managed safely in line with government guidance. COVID-19 testing, care plans and visitor plans were in place.

There were processes for managing incidents, accidents, safeguarding concerns and complaints to help make improvements to the service. There was evidence incidents were appropriately investigated so learning took place and relevant agencies such as the local authority and CQC were notified. The provider undertook audits and checks to monitor and improve the quality of the service.

The provider worked with external professionals to help ensure people’s health and wellbeing needs were met. Stakeholders across all groups felt able to raise any concerns with individual unit managers.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 9 January 2021).

Why we inspected

We received concerns in relation to risk about the care provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Court Care Home on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service using our monitoring systems which will inform when we next inspect the service.

Manor Court is a residential care home that provides personal and nursing care for up to 111 people. The service is divided into four units, but at the time of the inspection one unit, Beech, was being operated by the Clinical Commissioning Group (CCG). At the time of our inspection 81 people were living in the service's three other units.

People’s experience of using this service and what we found

During this inspection we found the provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. There were also systems in place to identify and mitigate risks. Medicines were managed and administered safely.

The provider had an infection prevention and control procedure in place and staff had attended relevant training to help protect people from the risk of infection. Safe recruitment procedures were in place and there were enough staff to meet people’s needs.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to 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 09 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 18 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Court Care Home on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Manor Court is a residential care home that provides personal and nursing care for up to 111 people. The service is divided into four units but at the time of the inspection one unit, Beech, was closed. Three units are for older people and one unit is for younger adults with physical disabilities. At the time of our inspection 56 people were living at the service. Some of the older people were living with the experience of dementia.

People’s experience of using this service and what we found

During this inspection we found medicines were not always managed safely and not all staff had completed medicines management competency testing to ensure their skills were up to date and they could administer medicines safely.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The principles of the MCA were not always being followed as staff did not always have a good understanding around people consenting to their care. We recommended the provider consider current guidance around the MCA and update their practice accordingly.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, during the inspection we identified areas for further improvement around medicines and consent to care.

We recommended the provider ensure there are a range of activities that meet the needs of all people using the service.

The provider had systems in place to safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. Safe recruitment procedures were in place and there were enough staff to meet people’s needs. Staff followed appropriate infection control practices to prevent cross infection.

Supervisions, appraisals and competency testing provided staff with the support they required to undertake their job effectively and safely. People were supported to maintain health and access healthcare services appropriately.

Staff were kind and provided support in a respectful manner. Staff respected dignity and promoted independence for people.

Families were welcomed to the service. There was a complaints procedure in place and people knew how to raise complaints with the manager.

People and staff reported the manager was approachable, making improvements and promoted an open work environment.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 24 September 2019). There were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Court Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people being cared for safely and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Manor Court is a residential care home that provides personal and nursing care for up to 111 people. The service is divided into four units but at the time of the inspection one unit, Beech, was closed. Three units are for older people and one unit is for younger adults with physical disabilities. At the time of our inspection 56 people were living at the service. Some of the older people were living with the experience of dementia.

People’s experience of using this service and what we found

Some of the provider’s care practices did not always ensure people living in the home were safely cared for. Risk management plans were not always followed. Incidents and accidents were not investigated consistently and did not always demonstrate learning outcomes to prevent future incidents. There were not enough staff effectively deployed to meet people’s needs and keep them safe. ‘When required’ medicines protocols did not always describe the person’s specific needs so it was clear when to administer these medicines. The provider did not always assess the risk of harm to people who used some paraffin-based creams.

Activity provision was not person centred, therefore people’s individual interests were not always met. Our observations during the inspection showed that people were not always treated with dignity and respect or in a person-centred manner.

The provider had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people but these were not always effective and had not identified issues we found at the inspection. Records regarding incidents and accidents, safeguarding and complaints was not always consistent in demonstrating how they had been investigated, followed through into the care plan and lessons learned recorded and disseminated.

Supervisions, appraisals and training were carried out regularly to develop skills staff required to undertake their roles. However, staff did not always demonstrate they had the skills and knowledge to meet people’s needs safely and effectively.

Staff knew how to respond to possible safeguarding concerns to help ensure people’s safety. Safe recruitment procedures were in place to ensure only suitable staff were employed to care for people.

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 prior to moving to the home. People were supported to maintain healthier lives and access healthcare services appropriately.

There was a complaints procedure in place and the provider knew how to respond to complaints appropriately. People and staff reported the registered manager was approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 5 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement in all the key questions.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Manor Court Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people being cared for safely, receiving person centred care, people being cared for with dignity, staffing and leadership at this inspection.

After the last inspection when we rated the service inadequate we took enforcement action against the provider. We have imposed a condition on the registration of Manor Court Care Centre that restricts the admission of new people to the home. We have also imposed other conditions on the provider that require them to send monthly reports to the CQC on the staffing arrangements in the home, the state of care planning for new service users and the findings of a number of checks and audits.

As we do not consider that enough improvements have been made at the home, we will continue with the conditions currently imposed on the registration of Manor Court care Centre.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Requires improvement’ and the service will remain in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service:

People were not always being safely cared for. They were placed at risk of harm and abuse because there were not enough preventative measures taken to keep them safe.

The risks to their safety and wellbeing had not always been assessed or planned for. This meant that the staff did not have the information they needed to mitigate risks and keep people safe.

Medicines were not always managed in a safe way and this meant people were at risk of not receiving the medicines they needed safely.

There were not always enough suitable staff deployed to meet people's needs and keep them safe.

The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and risks had not been mitigated.

Records were not always accurately maintained or up to date. This meant that people were at risk of receiving care which was not appropriate.

The provider did not always act in accordance with the Mental Capacity Act 2005. Therefore, people had not consented to their care and treatment and decisions had not always been made in their best interests.

People did not always receive personalised care which reflected their needs and preferences

Some people using the service were happy and experienced kind care and support.

People had access to healthcare services and the staff worked with other professionals to make sure people stayed healthy.

People had enough to eat and drink.

People being cared for at the end of their lives received the support and care they needed.

Rating at last inspection: The last inspection took place on 26 June 2018. At this inspection we rated the service good overall and for all of the key questions we ask.

Why we inspected: We carried out our inspection of 29 January 2019 because we had been alerted to concerns about the service. These included medicines errors, unexplained injuries and other safeguarding concerns. The local authorities who commissioned services with the provider and who carried out safeguarding investigations, had shared their concerns about the service with us.

Enforcement: We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Follow up: We will continue to monitor the service and will undertake another comprehensive inspection within six months.

Manor Court Care Centre is a '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.

Manor Court Care Centre accommodates 111 people across four separate units, each of which had separate adapted facilities. Three units were open at the time of the inspection. One of the units catered for people living with the experience of dementia, the second unit was for younger adults with a physical disability and the third unit accommodated older people and those who required end of life care. At the time of inspection one unit was closed and there were 73 people accommodated over the other three units.

The service 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.

Since our last inspection there had been significant improvements made with the auditing and monitoring of the quality of the service. Quality assurance systems were robust and being used effectively so shortfalls were being identified and addressed in a timely way. Record keeping had improved and we also found that people were receiving the care and support they wanted. Work was ongoing to identify further improvements.

People said they felt safe living at the service. Staff understood the procedures to follow to protect people from the risk of abuse and to report any concerns. Risks for individuals and for the service were assessed and action taken to minimise them. Systems and equipment were checked, maintained and serviced at the required intervals to keep them in good working order.

Staff recruitment procedures were in place and being followed to ensure only suitable staff were employed. There were enough staff available to meet people's needs and staffing levels were kept under review in line with changes in people’s needs.

Medicines were being managed safely at the service. Infection control procedures were in place and being followed. The registered manager used reflective practice to consider all aspects of the service including events so where shortfalls were identified lessons could be learnt.

People were assessed prior to coming to the service to identify their needs and wishes, which were recorded and were being met. Staff undertook induction training programmes and received ongoing training to provide them with the skills and knowledge to provide good care and support.

People's dietary needs and preferences, including those to meet people's religious and cultural needs, were being identified and met and a range of meals were provided. People were referred to healthcare professionals when needed and received the healthcare input they required.

The environment provided a homely place to live and each unit was appropriately decorated and furnished to meet the needs of the people who lived there.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). People were encouraged to have choice and control of their lives and staff supported them in the least restrictive way possible.

People and relatives were happy with the care and support people received. Staff treated people in a caring and gentle manner, with dignity and respect. Staff understood and respected people's individual wishes and did what they could to enable people to live the lives they wanted to.

Care records were clear, person centred and reviewed regularly to keep the information up to date. Activities were varied and took place each day and people enjoyed taking part. People and relatives felt able to express any concerns so they could be addressed. Where people were happy to discuss their end of life care wishes, these were recorded so they were known and could be met.

People and relatives knew who the registered manager was and said she was visible, approachable and responsive. They were well supported by the deputy manager and encouraged good teamwork throughout the staff team.

The registered manager and the deputy manager kept up to date with current legislation and good practice, and had implemented auditing and monitoring processes effectively to ensure all aspects of the service were kept under review.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Manor Court Care Centre is a ‘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.

Manor Court Care Centre accommodates 111 people across four separate units, each of which had separate adapted facilities. Three units were open at the time of the inspection. One of the units catered for people living with dementia, the second unit was for younger adults with a physical disability and the third unit accommodated older people and also those who required palliative care. At the time of inspection one unit was closed and there were 63 people accommodated over the other three units.

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 did not always receive the personal care they wanted and care records were not always up to date and/or accurate. Although auditing and monitoring processes were in place and being followed, action plans did not address all the shortfalls that had been identified, so were not effective in making sure areas identified for improvements were addressed. You can see what action we told the provider to take at the back of the full version of the report.

Since our last inspection, there had been improvements made with the completion of staff recruitment records, however auditing processes needed to be robust to ensure full compliance with the provider’s own recruitment procedures. Risk assessments for individuals and for systems, equipment and safe working practices were in place and identified the action to take to mitigate the risks. The provider made suitable arrangements to ensure people were protected against the risks associated with the inappropriate administration of medicines. Staff understood and followed safeguarding procedures. People and relatives felt people were safe living at the service. Processes were being followed to learn from incidents.

Staff were responsive to people’s needs although improvements with the activities provision at the service had been identified and were still in the process of being implemented. The provider had sought specialist advice and input to improve dementia care awareness among the staff, which had been partly effective, with more work required with the activities provision. There was a complaints procedure in place and this was being followed. People’s wishes in respect of end of life care were discussed and recorded.

Improvements were needed with recording and addressing feedback, for example, listening to people’s personal care needs and taking action to ensure any issues were being addressed. The service had several members of the management team and people and relatives were not all clear about who was in charge. The management team had taken steps to learn from improvements at another service run by the provider and work was ongoing to introduce new practices and documentation to enhance the service provision.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person centred care and good governance. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 111 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, including those who require palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back into their homes. People living there were able to stay at the home for up to six weeks. At the time of our inspection 84 people were living at the home.

The service is required a registered manager in post but did not have one at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The previous registered manager had left the service and a new manager had been in post since January 2017 and has applied to register with CQC.

Individual risks to people were assessed, however management plans to identify the action to be taken to minimise them were not always available. Risk assessments for equipment and safe working practices were not available in areas where equipment was being used. In many instances medicines were being managed safely but we identified a few instances where further attention to detail was needed to ensure they were always managed safely. The provider did not ensure that staff recruitment procedures were always followed to ensure only suitable staff were employed by the service. The processes for auditing and monitoring the quality and safety of services people received had not always been effective in identifying shortfalls within the service.

Systems and equipment were being serviced and maintained and incidents and accidents were recorded, investigated and monitored to minimise the risk of recurrence. Procedures were in place to safeguard people against the risk of abuse. Staff knew to keep people safe and to report any concerns.

Infection control procedures being followed to maintain a clean environment and protect people from the risk of infection.

There were enough staff on duty to meet people’s needs. Staff received training to provide them with the skills and knowledge to care for people effectively. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). Authorisations under DoLS were in place where required to ensure that people’s freedom was not unduly restricted.

People’s dietary needs and preferences were identified and met. People’s healthcare needs were recorded and they received the input from healthcare professionals as they required.

People were asked about the care and support they wanted to receive and said this was respected. Staff treated people with respect and cared for them in a kind and gentle way.

Care records were comprehensive and identified people’s needs and how to meet them. Daily records did not always reflect if people were being given the personal care choices they had made. At times their social and recreational needs were also not being fully met, because of a lack of staff allocated to support people with activities.

A complaints procedure was in place and people and relatives felt able to raise any concerns so they could be addressed.

People and relatives felt the management team were approachable and responded to any issues raised.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, fit and proper persons employed and good governance. You can see what action we told the provider to take at the back of the full version of the report.

The last inspection took place 24 November 2015 when we found breaches of three Regulations relating to consent to care and treatment, person centred care and good governance. At this inspection we found improvements had been made in all these areas. However, people living in one part of the service did not received personalised care and therefore the requirement to meet this breach had not been met.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 111 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, some who are receiving palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit was opened in 2015 and is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back home. People living there were able to stay at the home for up to six weeks. At the time of our inspection 82 people were living at the 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 and associated Regulations about how the service is run.

Parts of the building were not safe or clean and this meant people were at risk. In addition the environment did not always suit their needs or ensure their privacy was respected.

People living on Sycamore unit did not receive care which reflected their preferences and individual needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Most people living at the service were happy there and their needs were met. In particular people living in Beech unit received care which was personalised and reflected their individual needs and preferences. They were supported to learn new skills and to achieve personal goals which they had been part of developing. People living in Willow unit and Larch unit also received care which met their needs. Where possible they had been consulted about this and had consented to their care. The provision of social activities had improved on these units and people were able to participate in a range of events which were designed to interest them.

Families of people living at the service felt involved with the care of their loved ones. They were welcomed at the home and able to assist people if this is what they wanted. They told us they were informed about the care of their relative and were happy with the care provided.

The staff felt well supported and had the training and information they needed to care for people. There were enough staff and they were suitably employed. There were clear lines of responsibility and managers were available and accessible.

There were thorough systems for auditing the service and the care people received. These included regular checks on people's safety and wellbeing by the staff and senior managers within the organisation. Records were clear, up to date and well organised, with the exception of a small number of care plans which had some contradictory information. People received medicines in a safe way, and there were robust systems for ensuring medicines were safely managed. People were able to make complaints and felt these were listened to and acted upon.

The inspection took place on 24 November 2015 and was unannounced.

The last inspection of the service was on 19 May 2015 when we found breaches of Regulation relating to the management of the service, safe care and treatment, need for consent, person centred care and good governance. At this inspection we looked at whether these breaches had been met. Improvements had been made in all areas, although there were still some breaches of Regulation because there were not enough improvements in the way in which people’s consent was obtained and how their social needs were met.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 120 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, some who are receiving palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit was opened earlier in 2015 and is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back home. People living here are able to stay at the home for up to six weeks. At the time of our inspection 75 people were living at the home.

There was a manager in post. They had applied to be registered with the Care Quality Commission and were waiting for confirmation of their registration. 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 and associated Regulations about how the service is run.

Improvements had been made to the assessment of people’s mental capacity and recording their consent. However, these were not enough. Some people’s capacity had not been accurately assessed and information about this was not clear. Whilst some people had been asked to give recorded consent to their care and treatment, others had not and there was no, or limited information to show whether they consented to their care.

People did not always have the opportunity to take part in social activities which met their needs and reflected their preferences.

There were not always accurate, complete and contemporaneous records of the care planned and provided to each person.

Risks to people’s safety and wellbeing had been assessed and were being managed. The concerns identified at the last inspection had been addressed.

People’s medicines are managed so that they are received safely, with minimal risk of harm.

The provider had procedures to safeguarding people and the staff were aware of these and followed them.

There were enough staff to keep people safe and the recruitment procedures were designed to check staff suitability to work with vulnerable people.

Parts of the environment looked worn and were not thoroughly cleaned. However, the provider had a plan to address these, including the replacement of malodourous carpets. Other areas of the building were clean and well maintained.

The staff received the support and training they needed to care for people.

People’s healthcare needs were assessed, recorded and monitored. They had access to a range of healthcare professionals

People’s nutritional needs were met and their preferences and needs were recorded. However, people did not always feel the timings of meals met their needs.

People told us the staff were kind, caring and polite. We observed this, although some of the staff were focussed on the task they were performing and did not always explain what they were doing to people.

People’s privacy and dignity were respected.

People’s needs were assessed. Care and treatment were planned to meet these assessed needs.

There was an appropriate complaints procedure and people felt their complaints were investigated and acted upon.

There were not always accurate, complete and contemporaneous records of the care planned and provided to each person.

You can see what action we told the provider to take at the back of the full version of the report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in a suitable and safe environment. Their needs were recorded in individual care plans and there were checks to ensure these needs were being met. Any risks to people's safety and wellbeing had been assessed and action had been taken to reduce the risk of harm. People's medicines were appropriately stored, recorded and administered. The staff were well trained and supervised to make sure they cared for people safely. One visitor told us the home kept people safe and they felt comfortable and relaxed leaving their relative in the care of the staff.

Is the service effective?

People's health and personal care needs were met. Their individual needs had been assessed and recorded. They had access to their GP whenever they needed. The home catered for a range of different needs. Older people living at the home had opportunities to take part in different leisure and social activities. However, younger people who had a physical disability did not always have access to the stimulation and support they needed to improve their health and wellbeing. Although their care was coordinated by an appropriate healthcare professional, there were not always the resources or availability of other healthcare professionals to meet their individual needs. People living at the home and their relatives told us they were happy there and they felt their needs were met.

Is the service caring?

People living at the home and their visitors told us the service was caring. They said they had the things they needed and they were cared for in the way they wanted. The staff were kind and caring towards people, listening to them and respecting their choices.

Is the service responsive?

People's needs were assessed and changes in their needs were acted upon. There were systems to monitor individual wellbeing and these were well used. Where people had become unwell we saw appropriate action had been taken. People were able to make choices about their care and the staff responded appropriately to these. Where problems had been identified by the provider themselves, others or from CQC inspections action had been taken to address these problems and improvements to the service had been made.

Is the service well-led?

The staff working at the home told us they were well supported by their manager and had clear information and guidance. There were systems to monitor the quality of the service. We saw these had been used to identify areas of concern and to make improvements.

We spoke with five people who lived at the home. They told us that they liked living there. They said they were well cared for and they were able to do the things they wanted to. We spoke with one relative who was visiting. They said they thought the home had a ''lovely atmosphere''. They said they were happy with the care and treatment their relative received and were pleased with the support the staff gave.

We found that in general people's care needs had been identified and were being met. The provider had made improvements to the social activities on offer. They had also employed some specialist staff, offered more training to care staff and had plans for further improvements in meeting people's needs.

However, we saw that the staff did not always show respect to people living at the home. They did not always offer people choices or listen to the choices that they had made.

We asked the provider to make improvements following our last inspection on the 16 and 20 February 2013 because arrangements in place for obtaining people's consent to their care and treatment were not adequate. The provider sent us and action plan detailing how improvements would be made. We found people's care records had been reviewed and people's care was planned with their consent, or where they were unable to with the consent of relatives and advocates.

We found people's care was planned in relation to physical and healthcare needs. We observed how people were cared for and looked at records relating to people being supported with their communication. We found staff understanding of people's needs where they had difficulties in communicating was poor and required improvement. We also found that best practices regarding caring for people with dementia and Alzheimer's condition not always followed.

We looked at medication arrangements and found that people were given their medication by appropriately skilled and trained staff and appropriate audits and recording keeping was carried out to ensure people received their medication safely.

We looked at staff recruitment and found that there were appropriate arrangements in place to ensure staff employed to work in the home had sufficient skills and competencies.

One person's relative told us "my relative has been here for a number of years, I never really need to complain but sometimes I don't think they always change the juice in my relative's room on a daily basis."

We looked at the systems in place for people consenting to their care and treatment and found these were not adequate. The arrangements did not comply with good practice and the law.

We found people had detailed assessments prior to receiving care from the service and their care had been planned in accordance with their needs.

We looked at the systems that were in place for ensuring people were protected from the risks of abuse. We found the arrangements in place were effective. We also found that staff were supplied in sufficient numbers with suitable qualifications and experience to ensure they received effective care and treatment.

We spoke to people and their relatives about the provider's complaints system. We were told people would know how to complain if they needed to.