Manley Court Care Home

Manley Court Care Home is a residential care home providing personal care for up to 85 adults. At the time of the inspection 73 people were living at the service, including older people and people living with dementia.

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

We found no evidence during the inspection that staffing levels were not sufficient.

People’s relatives told us they were happy their family member was being kept safe and there were sufficient staff on duty.

The provider had made a range of improvements in relation to care records and quality assurance processes. Despite general improvements further improvements were needed.

Staff told us they felt adequately supported by managers.

Rating at last inspection and Update

The last rating for this service was requires improvement (published 27 February 2023).

Why we inspected

The inspection was prompted in part by information of concern we received about staffing levels. We undertook a targeted inspection to look at staffing levels, and quality assurance processes.

We found no evidence that the service did not have sufficient staff. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We did not look at all aspects of the previous breaches of regulations at this inspection. We will follow up on breaches of regulations when we next inspect.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Manley 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, which will help inform when we next inspect.

Manley Court Care Home is a residential care home. At the time of the inspection the service was providing personal and nursing to 80 people, some living with dementia or physical and learning disabilities. The service can support up to 85 people. The accommodation was spread over four separate units all with communal living and dining areas.

People’s experience of using this service

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Risks to people’s health and wellbeing were assessed and individual risk management plans were put in place to help mitigate risks. We found when some people became agitated staff could not support them effectively and others sufficient details were not included in their care records to support them.

People shared mixed views of whether they were happy living at the service. While some people said they felt safe and staff were caring others said staff were too rushed during the day to ask for help. The numbers of staff available were not always at the provider’s recommended levels to meet people’s needs safely. People told us that they were not enough staff on duty.

There were systems in place for people to have their medicines as planned. However, we found that some aspects of medicine management were not robust.

There was a safeguarding policy and process and staff had completed training on safeguarding and protecting people from abuse. Records showed that safeguarding log was not always up to date. This meant there was a potential risk that people were not effectively protected from harm and abuse.

People were not supported to have maximum choice and control of their lives and staff did not 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.

Staff followed infection control and prevention (IPC) guidance to protect people from infection including COVID-19. Staff wore protective personal equipment (PPE) and we observed the service was clean and hygienic throughout. The service’s IPC and COVID-19 policies were up to date. Managers contacted their local health protection team in a timely way when they suspected a COVID-19 outbreak.

Rating at last inspection

The last rating for this service was requires improvement (Report published 8 July 2021).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 March 2021. 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 the concerns about staffing levels, the quality of care records and the monitoring of the service.

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.

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 remained requires improvement for the second consecutive inspections. 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 Manley Court Care Home on our website at www.cqc.org.uk.

Enforcement

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. We have identified continued breaches in relation to good governance and staffing and a new breach in safe care and treatment. We have made a recommendation in relation to person-centred care.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manley Court Care Home is a residential care home. At the time of the inspection the service was providing personal and nursing to 75 people, some living with dementia or physical disabilities. The service can support up to 85 people. The accommodation was spread over four separate units.

People’s experience of using this service

People said they were happy living at the service. Relatives gave positive comments about the experience of care and the management of the service. A relative said, “Nothing is too much trouble for the staff, I have no worries about my [family member].”

The numbers of staff available were not always at the provider’s recommended levels to meet people’s needs safely. We observed delays in people receiving their meals in a timely way. Staff told us they often had to provide care alone when two staff members were required. This increased the risks to people receiving care and to staff.

Staff implemented the provider’s safeguarding processes and their training to identify and protect people from harm and abuse. The registered manager ensured allegations of abuse were reported to the local authority for investigation. However, we found the Care Quality Commission were not always sent safeguarding notifications as required by law.

There were systems in place to record assessments, plans of care, medicine administration and daily progress. These records helped staff to monitor people’s progress effectively. Staff assessed risks to people’s health and wellbeing and developed plans to mitigate these. However, we found that care and management records were not always organised in a logical way which made it a challenge to review them.

There were suitable measures to protect people from COVID-19, including the use of protective personal equipment (PPE), testing and vaccination. The service was clean and hygienic throughout, with enhanced cleaning of frequently touched surfaces to protect people from cross infection. The service had a designated infection prevention and control (IPC) lead who had been trained and was knowledgeable about the current guidance. The service’s IPC and COVID-19 policies were up to date. Managers contacted their local health protection team in a timely way when they suspected a COVID-19 outbreak.

People and their relatives were kept informed of changes and developments in the service. They were able to provide feedback about the quality of care and the service.

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.

Rating at last inspection

The last rating for this service was good (published 23 June 2020).

Why we inspected

We received concerns in relation to staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only.

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.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-led sections of this full report. We have made two recommendations about recruitment and engaging with staff. We found breaches of regulation related to good governance and staffing.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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. We have identified breaches in relation to Staffing and Good governance.

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 and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Manley Court Care Home accommodates up to 85 people in one purpose-built home. At the time of the inspection, 76 people were living in the service. Manley Court Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The service comprises four separate units, each of which has individual adapted facilities. Two of the units specialise in providing care to people living with dementia. Another unit specialises in supporting younger adults, and the fourth unit supports older adults.

We found the following examples of good practice.

The service introduced infection prevention and control (IPC) Champions, who discussed and promoted good IPC practices with people within the care home.

The provider followed best practice guidance to ensure visitors to the home did not introduce and spread COVID-19. Information and instructions for visitors were displayed and explained in person by the receptionist. Staff were adhering to personal protective and equipment (PPE) and social distancing guidance.

The provider created a purpose-built glass port at the rear of the building, used for visits. Visitors accessed it externally while their relative sits inside and speaks through an intercom. Alternatively, staff supported people to talk to their families on the phone or via video call.

The provider had a COVID-19 policy that outlined the requirement for isolation rooms for people infected with COVID-19 or people admitted to the home from the hospital or the community.

The provider had ensured staff who were more vulnerable to COVID-19 had a risk assessment in place, and where it was not safe for staff to be at work, they had a furlough scheme in place to protect staff and people.

On the 21 and 24 July 2017, we carried out a comprehensive inspection. We found continued breaches in good governance and staffing. New breaches in safe care and treatment and meeting nutritional and hydration needs were also found. The service was rated as Requires Improvement overall. You can read previous inspection reports of the service, by selecting the ‘all reports’ link for Manley Court Care Home on our website at www.cqc.org.uk.

At this inspection we followed up on the breaches of regulations to see if the registered provider had made improvements as required. We found that the provider and registered manager had taken sufficient action to address the concerns from our previous inspection. We have made one recommendation regarding the management of percutaneous endoscopic gastrostomy (PEG) to keep people safe.

There was a registered manager employed at the service. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

The provider’s safeguarding policy and processes were followed by staff. Staff knew how to keep people safe from abuse and report an allegation of abuse promptly. Staff had safeguarding adults training and used this knowledge to protect people from the risk of harm.

Risks to people were assessed and managed to keep people safe. Staff had improved the quality of the risk assessments which included a risk management plan to provide staff with guidance on how to manage those identified risks.

Medicines for people were managed safely. Staff were assessed as competent and safe to support people with the administration of medicines. However, we did find a recording error of a controlled medicine which was addressed immediately by staff.

There was sufficient staff working at the service. The dependency tool reviewed and assessed the number of staff required to care for people safely.

The registered manager supported staff working at the service. An induction programme, training, supervision and annual appraisal were available for staff.

Staff understood their responsibilities under the Mental Capacity Act 2005 and protected people’s rights. People’s care records showed that they were asked for their consent. Care documents were signed and agreed to by people or by their relative on their behalf.

There was a menu from which people could choose their meals. Meals provided at the service met people’s preferences. Staff provided nutritional support and a specialist diet when this was required.

Staff made referrals to health and social care professionals for advice. There were regular multi-disciplinary meetings that occurred at the service. These meetings ensured health and social care professionals provided support to people to maintain their health and well-being.

People said staff respected them and ensured their privacy was protected. We saw staff carrying out care and support in privacy which promoted their dignity.

People and their relatives were involved and contributed to an assessment of their care. This ensured staff could meet the needs of people using the service. Care plans were used to describe the planned care and support people would receive. Care and support was reviewed on a regular basis to ensure the care and support remained relevant. Staff helped people to develop their end of life care plans. Staff discussed people’s wishes and these were recorded so that people’s needs and preferences were met at the end of their lives.

There was a complaints system for people and their relatives to discuss their concerns about the service. People and their relatives said they were confident issues they had discussed with the registered manager or other senior staff available would be dealt with well.

The registered manager fulfilled their requirements of their registration with the Care Quality Commission (CQC). We were kept informed of incidents that occurred at the service. Staff we spoke with said they were happy working at the service. They added that they were supported by the management team and respected the registered manager.

Audits of the service occurred on a regular basis. There was a system in place to monitored and review the quality of care, an action plan was developed if there was a shortfall in the quality of care.

On 18 and 23 March 2016 we carried out a responsive inspection in relation to information of concern we received. We found a continued breach of the regulations related to staffing levels. We also identified new breaches of regulations in regards to good governance, safeguarding service users from abuse and improper treatment, the need for consent and notifications. The service was rated as Requires Improvement overall. You can read previous inspection reports of the service, by selecting the ‘all reports’ link for Manley Court Care Home on our website at www.cqc.org.uk.

Currently the Care Quality Commission (CQC) and the Fire Authority continue to be involved in investigations of the concerns we were informed of.

We followed up on the breaches of regulations to see if the registered provider had made improvements to the service. We found that the registered provider had taken some action to meet the regulations. The improvements we found were in relation to safeguarding service users from abuse and improper treatment, need for consent and notifications. However we found continued breaches in good governance and staffing. New breaches in relation to safe care and treatment and meeting nutritional and hydration needs were also found.

The registered provider had employed a new home manager after our last inspection and they had successfully completed their application with the CQC to become the registered manager. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

We found that people had risk assessments in place. Staff identified risks to people’s health and wellbeing. However we found that the control measures in place to manage people’s risks including the risk of harm from fire were not always followed to keep people safe.

Medicines were not managed safely. We found medicine administration record (MAR) charts were not accurate or up to date and medicines were not always stored safely. People were at risk of receiving medicines that were not administered as prescribed.

People who used the service, relatives and members of staff continued to raise concerns about the level of staffing at the service. The dependency tool in place assessed the number of staff required to meet people’s needs. We found that at times staffing levels did not always meet the needs of people living at the service.

Records relating to people’s ability to consent to care and support were not always accurate or up to date. Staff sought people’s consent to care. This was obtained in writing for complex decisions and verbally from people using the service for simple decisions that needed to be made.

The meals provided at the service met people’s preferences. Where people required a specialist diet this was provided to help them maintain their health and wellbeing. However, we found that people’s nutritional needs were not always effectively met.

Health and social care professionals were involved in people’s care and support needs when required. People had access to health and social care services when their needs changed.

Staff understood what action to take to keep people safe from abuse. Staff followed the registered provider’s safeguarding procedures to protect people from the risk of harm. People told us that staff listened to their views and opinions. Staff provided care to people that showed that they respected their dignity and privacy.

Staff had received appropriate support from their line manager. Staff had access to training, supervision and annual appraisals to support them in their role. New members of staff had an induction which helped them to familiarise themselves with people using the service and the registered provider’s policies and processes.

Care assessments were carried out for people using the service. Staff completed assessments of need to ensure the service could manage their care and support needs. Care plans were developed after an assessment. These gave staff guidance on the support people required to meet their assessed needs safely.

The registered provider had a system in place for people to make a complaint about the service. People and relatives told us that they knew how to make a complaint about the service and care they received.

The registered manager understood their responsibilities in relation to their registration with CQC. Staff we spoke with told us that they respected the registered manager who listened to and acted on their concerns. Internal audits were completed by staff to monitor and review the quality of service provision for people using the service, however these audits had failed to identify and address the shortfalls we found during the inspection.

We found that the service was in breach of the regulations related to safe care and treatment, nutrition and hydration, staffing and good governance. You can see what action we have told the provider to take at the back of the full version of this report.

Manley Court Nursing Centre provides accommodation and nursing care for a maximum of 85 people. At the time of our inspection, 75 people were using the service. The home provides care for older people, some of whom have dementia and adults with a physical disability.

The home was last inspected on 16 and 17 April 2015. At the time the service was in breach of a regulation relating to staffing levels. The provider had not ensured the staffing levels were adequate to meet the care and support needs of people adequately and safely. We also made recommendations in relation to staff supervisions and appraisals, team building and effective temperature control systems for the medicine room.

You can read previous inspection reports of the service, by selecting the ‘all reports’ link for Manley Court Nursing Centre Unit on our website at www.cqc.org.uk.

The previously registered manager of the service had left since our last inspection. At the time of inspection, the home had a manager who had applied for the Care Quality Commission (CQC) registration. A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

At this inspection we found that the provider had not addressed all the concerns we had at our last inspection. We found that sufficient actions had not been taken in relation to low staffing levels and the service continued to be in breach of the relevant regulation.

We found four new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing (regulation 18); good governance (regulation 17); safeguarding service users from abuse and improper treatment (regulation 13); need for consent (regulation 11); Also, a breach of the CQC (Registration) Regulations 2009 for notification of other incidents.

Prior to the inspection the CQC had been informed of a concern about an aspect of the service. This was being investigated by other agencies at the time of the inspection. CQC will continue to monitor the progress and outcome of this investigation.

We found that people’s risk assessments and care records were inadequately completed. This meant that information was not shared as required and people’s safety was put at risk.

The service followed safe staff recruitment procedures. Staff were aware of potential signs of abuse to people and supported people to managed risks as required. This help to ensure that people received the care they needed. People had support to take their medicines safely and as prescribed.

The service had not carried out regular supervision and appraisal to ensure that staff had the support required. People’s mental capacity assessments were inadequately completed. There was a risk that people’s capacity was not assessed in a way that met their needs. The service had not met the Deprivation of Liberty Safeguards conditions to ensure that people were not unlawfully restricted.

Staff attended regular training courses that were relevant to their role and ensured effective care provision for people. Systems were in place to support staff during their induction period. This meant that newly employed staff had the knowledge to support people with their needs. Staff assisted people to make decisions on a daily basis and ensured that the support was available for people when they required help to make more complicated decisions. People had their nutritional needs met. Staff worked together with health professionals to provide continuous and effective care for people. People received support with their health appointments as required.

People said they had good relationships with staff who attended to their support with care. Staff were aware of people’s communication needs and helped them to make decisions for themselves. People were supported to plan their care and staff took people’s views in into account when providing support. The service provided people with a choice of food they wanted to eat. People felt they were treated with respect. Staff ensured that people’s privacy was maintained. The service supported people to maintain relationships with their families.

People had their care and support needs assessed which ensured they received the care required. Staff were aware about people’s individual needs and preferences. People had a choice of the activities they wanted to attend. The service supported people and their relatives to express their concerns where required. However, some family members we spoke to felt their complaints raised were not adhered to appropriately and therefore were reluctant to complain.

The service had not sent the CQC notifications in relation to the outcomes of Deprivation of Liberty (DoLS) applications.

Staff told us the new manager provided them with guidance and support where needed. This meant that staff were supported to carry out their roles effectively. Staff had different opinions in relation to the team working practices at the service. Some staff felt that relationships between the staff team were good, whereas others thought the relationships between the care assistants and nurses could improve. Staff said that their suggestions about the working practices were not taken into account, which meant that they were not involved in developing the service. The service used effective quality assurance systems to monitor the care and support provided for people.

Is the service safe?

Staff were trained to support people safely. Risks were assessed for people and plans were in place to address identified risk. Staffing levels were adequate and staff were trained and competent in their roles. There was a plan for how staff should respond to emergencies. Medication was not handled safely and the stock of medical devices available was not always suitable for use. The service had care staff on duty 24 hours a day. People told us they felt safe living at the service. Appropriate moving and handling equipment was provided for people who had mobility needs and staff had received training in using them. Safeguarding alerts were taken seriously and appropriate actions taken.

Is the service effective?

People's care was planned and delivered in a way that met people's individual needs. The provider involved other healthcare professionals in the planning and coordination of people's care and treatment. People were supported to take part in activities taking place at the service and in the community.

Is the service caring?

Staff understood the needs of people they supported. People who used the service told us that they were treated with dignity and respect and staff were caring and nice to them. Staff interacted and responded to people in an open and positive manner. We observed that staff knocked on people's doors before entering. Staff communicated with people in the way they understood.

Is the service responsive?

Care plans and risk assessments were reviewed monthly to reflect people's changing needs. People were given the assistance they required to eat and drink. The provider liaised with other health and social care professionals to address any concerns about a person's care and welfare. Staff responded to people's calls for assistance promptly.

Is the service well-led?

There were quality assurance systems in place to identify, assess and monitor the quality of service provided. We saw records of complaints and actions taken to address them. People and their relatives had meetings with managers and discussed concerns. The provider carried out monthly reviews of the service. Customer satisfaction surveys were conducted annually. There had been instability in management for over a year. On the day of our inspection the relief manager in post told us that it was their last day and a new interim manager would be starting the following week.

We found there had been improvements in care planning, risk assessments and pressure area care, and staff demonstrated that they were familiar with the care plans of the people allocated to them. However we found some plans put in place to ensure people were regularly turned, to prevent pressure ulcers occurring, were still not being fully followed and staff were not always following instructions relating to tube feeds. The provider was unable to provide evidence of some of the improvements we had been told had been implemented.

We found that staff had received an increased amount of training, and regular reviews of staffing levels were being carried out.

At the time of our last inspection in July 2013 we found the provider had failed to notify us of a serious incident which affected the welfare of a person using the service. On this visit we found that the Care Quality Commission (CQC) had been appropriately notified of incidents.

We found that staff were not accurately completing all records relating to the care and treatment of people using the service.

We found that people were not always treated with dignity and respect. For example we saw that people were not always given a daily shave, when they wished for one; and people who needed help with their meals had to wait unnecessary for assistance.

We saw that care plans were not always up to date, and staff were not always following the care outlined in the care plans. Staff were not maintaining appropriate records in relation to fluid intake and pressure area care for people who needed monitoring.

People using the service were not provided with suitable activities. We saw that people were left unattended in the lounge for considerable periods of time.

We found that there were not enough staff to meet the needs of the people on the unit, and staff who were present did not have sufficient knowledge, skills and experience to care for people with dementia.

There were a number of activities on offer, and a designated activities coordinator was employed. There was a specific programme in place to meet the needs of people with dementia. We also found that inadequate steps had been taken to ensure people's consent was obtained.

We found that staff knew what action to take if they felt a person was at risk from abuse. Staff received regular training and supervision and said they felt supported by the provider.

We found that there were not always enough staff on duty at night to care for the number of people with dementia living in the home.

We found that the provider had systems in place to assess the quality of the care being provided; but that not all of the care records and risk assessments were up to date.