The inspection took place on 17 and 22 October 2018 and both days of our visit were unannounced.

Manor Court Home is a ‘residential care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 24 older people; living with physical frailty. Some people lived with dementia and / or other health conditions. At the time of our inspection visit 23 people lived at the home that has four floors.

The service is provided by Swinnerton Trust Limited, which was first established in 1951 to provide care and support for older people who live in the local area. The trust purchased the property, Manor Court Home, in 1952, refurbished it and converted it into a care home, to fulfil the aims of the charity.

A requirement of the services’ registration with us is that they have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had come into post during April 2018 and had become registered with us in September 2018.

At our previous inspection in January 2018, we found breaches in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. There had been no registered manager in post since October 2016. We found the Board of Trustees did not have sufficient knowledge of the Regulations to ensure compliance with the requirements of leadership and good governance. The assistant manager and staff were not supported by an appropriately skilled and experienced leader. We gave a rating of ‘Inadequate’ in well led and served the provider with a Warning Notice. The overall rating of the home was ‘Requires Improvement’.

At this inspection, we looked to see how the provider and new registered manager had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found that sufficient improvements had been made to meet the terms of the Warning Notice, further improvements were needed in the governance of the service and the oversight of staff practices. We found breaches in the regulations that related to the safety of the service. Further improvements were required in how the provider and registered manager assured themselves they were providing a safe service, that ensured people’s health and welfare needs were fully met. The rating continues to be ‘Requires Improvement.’ Further improvements were planned for in the number of staff on shift and updates in staff training. Plans to improve systems and processes to check and monitor the quality of the services provided were shared with us.

Since our last inspection, the newly appointed manager had become registered with us. The provider recognised that the trustees of the charity did not have the skills, knowledge or experience required to provide the support needed to the registered manager to make the required improvements and had appointed a business consultant. The provider’s business consultant had undertaken visits to the home and produced reports, with suggested actions, for the provider and registered manager.

Staff and people were positive about the newly appointed registered manger, who had introduced some systems and processes to monitor the quality of the service. However, these were not fully effective or embedded in every day practice. The registered manager shared their action plan with us, that included timescales, for further improvements to be made to the services provided. For example, staff were to undertake updates in training

Manor Court 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 care home accommodates up to 24 people in one adapted building. Nineteen people were living at the home at the time of our inspection visit.

Since our previous inspection in February 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The service is provided by a charitable trust, Swinnerton Trust Ltd, which was first established in 1951 to provide support for older people who live in the local area. The Trust purchased the property, Manor Court Home, in 1952, refurbished it and converted it into a care home, to fulfil the aims of the charity.

The Chairman of the Board of Trustees had been appointed in 2014, but was not appointed as the Nominated Individual’ (NI) or representative for the provider, at the time of our previous inspection. In October 2017, since our previous inspection, the Chairman had been appointed as the Nominated Individual, that is, the person we communicate with about the service. During our inspection, the Chairman represented the Board of Trustees. We refer to the Chairman as ‘the provider’ in our report, but legal responsibility for the service is shared jointly by the whole Board of Trustees.

At the last inspection in February 2016, the service was rated Good. At this inspection we found improvements were required in the management, leadership and governance of the service, which also had an impact on the safety and responsiveness of the service and the overall rating.

There was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The previous registered manager had left the service in September 2016. The provider had appointed the deputy manager as the manager, and relied on the manager to take over the responsibilities of a registered manager. The provider had invited the deputy manager to apply to become the registered manager, but they had not successfully submitted an application to become registered. We refer to the deputy who was managing the service as ‘the manager’ throughout our report. Because there is no registered manager at the service, all oversights and omissions are the responsibility of the provider that is, the Board of Trustees

The provider did not demonstrate knowledge of the Health and Social Care Act Regulations 2008, but had relied on the manager to know how the Regulations applied to the service. The provider had not given the manager sufficient access to training in the requirements of being a registered person. The provider had not given the manager sufficient support, guidance or mentoring to equip them for the role of a registered manager. During our inspection visit, the manager told us they had decided not to apply to be the registered manager. They said they felt they needed more time to acquire sufficient knowledge and skills to be confident to be legally responsible for the service.

None of the Trustees of the Board had stepped in to guide, mentor or support the support the manager to understand the requirements of the delivering a registered service in accordance with the Regulations. They had no

We carried out an unannounced inspection at Manor Court Care Home on 18 February 2016.

Manor Court is a residential care home providing accommodation for up to 23 people who require personal care. The home has three floors and access to a large and well maintained garden. All of the rooms had ensuite facilities and all floors had access to a lift and stair lifts. At the time of our inspection visit there were 22 people living at the home and there was one vacancy.

Manor Court Care Home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they liked living at Manor Court and felt safe. Peoples’ care had been planned and agreed with them. Risks were managed well and there were clear care plans drawn up to keep people safe, while at the same time optimising their independence.

Staff had a good understanding of safeguarding, could describe what abuse was and knew the reporting systems if any allegations of abuse were raised. There were sufficient numbers of staff to ensure safe care and support. Staff recruitment processes ensured staff were suitable and safe to work in the home. People received their medicines safely.

Manor Court was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). We saw people were encouraged and supported to be independent.

Staff knew people well and supported people in accordance with their individual preferences and needs. Staff received the training and support they needed to carry out their roles.

Peoples’ privacy and dignity was respected and maintained. People highly commended staff and commented on their compassion and motivation. We saw people were supported and cared for by kind and respectful staff.

Each person’s needs were assessed and this included obtaining a detailed life history of people. Care plans showed how peoples’ needs were to be met and how staff should support people. Care and support was tailored to each person and reflected peoples’ preferences. People were supported by staff to access healthcare services as and when needed.

Staff supported people to engage with stimulating and interesting activities of their choice.

People had the nutrition they needed to maintain their health and wellbeing. People said they had an “excellent” choice of food and drink available. The provider consulted people about the food and meal choices. People’s nutritional needs were assessed and monitored.

People and staff told us the home was well- led and we saw satisfaction surveys and monthly meetings ensured peoples’ views were heard. There were a range of audits in place which checked the effectiveness, safety and quality of the service which the provider used to make any improvements.