This inspection took place on 11 July 2018 and was unannounced. Manley Court Care Home accommodates up to 85 people in one purpose built home. At the time of the inspection 77 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 single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is made up of four separate units, each of which has separate adapted facilities. Two of the units specialise in providing care to people living with dementia. Another unit specialises in supporting younger adults and the forth unit supports older adults.

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

This inspection took place on 21 and 24 July 2017 and was unannounced. At the time of the inspection there were 77 people using the service. Manley Court Care Home provides accommodation with nursing care for up to 85 people. People using the service are younger adults and older people, some people are living with physical health difficulties, and others with dementia.

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 t

This inspection took place on 18 and 23 March 2016 and was unannounced. We received information of concern and as a result we brought our planned inspection forward.

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

Two inspectors carried out this inspection at Manley Court following concerns received from a member of the public. During the inspection, information was gathered to answer five key questions; is the service safe, effective, caring, responsive and well-led? We spoke with six people who used the service, five staff and four relatives. Below is a summary of what we found.

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 that staff were engaging with people using the service. They told us they had undergone training that had given them a better understanding of caring for people with dementia. Staff were able to demonstrate an understanding of the importance of seeking consent to care and treatment from the people using the service; and why assessments of capacity and best interest meetings might be held.

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 carried out this inspection in response to concerns expressed to the Care Quality Commission regarding the care and welfare of people living in one of the dementia units in this 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.

We talked with people using the service, and relatives. They told us they were asked about their care and were involved in its planning. They felt they were consulted before care was given. Relatives told us that they felt their family members were treated respectfully, and with care. One relative told us "the care is outstanding. I cannot fault anyone. They pay attention to the smallest detail".

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.

People told us that staff treated them well and were “caring.” Three of the seven people we spoke during our visit told us that they had been involved in the initial needs assessment process for people living in the home.

Two relatives told us that they were not happy with the level of care provided in the home and felt that the home did not always respond to concerns in a timely manner. However, three other relatives and a person using the service that we spoke to during our visit said that the home was responsive to their needs and concerns.

All of the people we spoke with using the service told us that they felt safe in the home.

Some relatives we spoke with said that sometimes there were not enough staff on duty. Some relatives also felt that some staff relied on them to help loved ones living in the home.

Manley Court provides accommodation and nursing care to up to 85 older people, some of whom had dementia. There were 76 people using the service at the time of this inspection.

This inspection took place on 16 and 17 April 2015 and was unannounced. The last inspection of Manley Court took place on 31 July 2014 where we found that the service was not meeting the regulations relating to the management of medicines and the safety of equipment. We asked the provider to take action to make improvements. They sent us an improvement plan on how they would address the issues and at this inspection we found that the provider had made the required improvements.

The service did not have a registered manager. The manager had submitted an application for registered manager to the Care Quality Commission. 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.

Staffing levels were not sufficient to adequately meet the needs of people at the service. Staff were not properly supported and supervised to ensure they were effective in their roles.

The manager held regular meetings with staff to update them about the service. We saw that issues staff raised were not always addressed. Staff morale was low. Staff felt that they were not listened to and involved in the running of the service. There was high turnover of staff which was impacting on the morale of staff. People told us that the agency staff did not understand their needs.

People received care and support in a safe way. The service identified risks to people and had appropriate management plans in place to ensure people were as safe as possible. . Medicines were kept securely and people received their medicines as prescribed.

Staff were knowledgeable in recognising the signs of abuse and knew how to report it by following the provider’s safeguarding procedures.

The manager understood their responsibility to protect people under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).Staff had been trained in the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed and best interests decisions were in place where required. People were not unlawfully deprived of their liberty.

People had their individual needs assessed and their care planned to meet them. People received care that reflected their preferences and choices. Reviews were held to ensure that the care and support people received reflected their current needs.

We observed that people were treated with dignity and respect by the staff. People told us they enjoyed the food provided and their nutrition and hydration needs were met.

Training programmes had been developed to ensure staff had the skills and knowledge to provide care to the people they looked after.

There were a range of activities that took place to keep people occupied. Those who were unable to participate in group activities were able to enjoy one-to-one activities in their rooms.

The service held meetings with people and their relatives to obtain their views about the service and to involve them in the running of the service. The feedback received was acted on.

The manager responded appropriately to complaints about the service. Systems were place to assess, monitor and improve the service to ensure it was of good quality and met people’s needs.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We have made recommendations in relation to providing a system to control the temperature of the medicine room, about putting effective system in place to support, supervise and appraise staff; and about motivating staff and team building