The last inspection took place on 26 January 2018 and we found the service required improvement at this time. Following the last inspection, we met with the provider to ask the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection we were assured improvements had been made to people’s safe care and treatment, person-centred care, recruitment processes and staff training. We found some improvements had been made to how people consented to care and treatment but found the home still required improvement in this area. We found some improvements had been made to how the home was managed but found the home still required improvement in this area.

Manorcroft is a ‘care home’. People in care homes receive accommodation and 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.

Manorcroft is registered to provide accommodation, personal care and nursing care for up to 40 people. There were 37 people living at the home on both days of our inspection. Manorcroft is a large two storey purpose built building offering accommodation across two floors accessed by a passenger lift. Each floor has a communal lounge and bathrooms. Outside there is a garden and patio area with seating.

The home had a registered manager who was available throughout our inspection. 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 felt very safe living at Manorcroft and their relatives felt assured their family member was safe. Staff had received safeguarding training and knew how to identify and report suspected abuse and knew the procedure to report any incidents.

Staff received training and support required to meet people’s needs. Recruitment procedures were robust to ensure suitable staff worked in the home. People were cared for, or supported by, sufficient numbers of staff.

Standardised risk assessments were used in care plans so risks to people’s health and safety could be effectively tracked and monitored.

Medicines were administered safely and with due consideration to national guidance.

The registered manager had audit systems in place, including for monitoring accidents and incidents, although not all checks were documented thoroughly, for example, the registered manager told us they undertook a daily walkround of the home but there was no documentation to support this.

Care plans contained personal histories and people’s preferences in relation to their physical needs. People were offered choice and their care plans contained some mental capacity assessments. Consideration had been given to people’s consent, and some consideration given to people’s capacity to do so for some aspects of care and support needs. Applications to lawfully deprive people of their liberty (DoLS) had been appropriately submitted to the local authority and were well managed. However we found some instances were people had not had their individual rights upheld.

Training was available and took place although some people had not been trained there were plans in place to do so. Staff supervisions and appraisals were taking place however these had not been undertaken in line with the registered provider’s policy.

People were provided with a good choice of freshly prepared food and snacks and drinks were available throughout the day.

People were supported to receive access to healthcare which was demonstrated and recorded in care plans.

People were consulted and had been involved in the refurbishment of the home, choosing colours and items for both communal areas and thei

The inspection took place on 6 and 11 December 2017 and was unannounced. We previously carried out an inspection in February 2015, where we found the provider was meeting all the regulations we inspected. Although we asked the registered provider to take action to make improvements to the storage of some confidential records. At this inspection we found some confidential were not locked away, however, this was rectified on the first day of our inspection.

Manorcroft is a ‘care home’. People received 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.

Manorcroft accommodates up to 40 people on two separate floors with a lift or stairs access to the upper floor. People had ensuite facilities in their bedrooms with communal bath and shower rooms located on each floor. On both days of our inspection there were 37 living at Manorcroft. People with both residential and nursing needs were supported on both floors.

At the time of our inspection the home did not have a registered manager. The manager was in the process of submitting the application form and other relevant documentation to the Care Quality Commission to become the 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.

People told us they felt safe in the home and staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. However, risks to people were not always identified and managed safely, accident and incidents were not always analysed accurately and some areas of medicines were not well managed.

People were offered choice; however, the care plans did not always contain decision specific mental capacity assessments. Deprivation of Liberty Safeguards were mostly well managed.

Staff did received training and support required to meet people’s needs. Recruitment procedures were not robust to make sure suitable staff worked with people who used the service. We found people were cared for, or supported by, sufficient numbers of staff.

People’s care plans did not always contain sufficient and relevant information to provide consistent, person centred care and support.

People’s mealtime experience was good and people received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity and people were able to individualise their bedrooms.

People and relatives told us they found the manager approachable and they listened to them. We found some of the quality assurance systems needed to be improved to ensure people received a consistent quality service.

The manager and staff explained they knew people well and as such they provided a person-centred approach to end of life care.

Throughout our visit, people were treated with sensitivity, kindness and compassion. Staff had a good rapport with people. People told us they liked living at Manorcroft and they were well cared for. Relatives told us their family members were well looked after. People enjoyed the different activities available and we saw people smiling and engaging with staff in a positive way. Staff understood how to treat people with dignity and respect and were confident people received good care. We observed people were well cared for. People were supported to remain independent and advocacy services were available if required.

The home was clean and tidy and there were effective systems in place to reduce the risk and spread of infection. People and relatives told us they knew how to complain and were confident the manager would address their concern

This inspection took place on 5 February 2015 and was unannounced. When we last inspected Manorcroft in September 2014, the home had just been purchased by the new provider Silverline Care Ltd but was still being managed by the previous provider. At that inspection we found the home was failing to meet the standards required in all of the regulations we assessed. We told the provider that improvements must be made. Since that time Silverline Care Limited have taken over the management responsibility at the home and have worked with the Care Quality Commission to affect improvements in service delivery to the people who live at Manorcroft.

Manorcroft is registered to provide nursing and residential care for up to 40 older people. The home is set over two floors each with two wings. There were 24 people living at the home at the time of our inspection.

At the time of our visit there was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider has been actively involved in trying to appoint a manager since our last inspection.

We found that the new provider had taken sufficient action to meet with all of the compliance actions set as a result of our inspection in September 2014.

People told us they felt safe and staff knew how to maintain people’s safety.

The home was clean and refurbishment and redecoration was in progress.

Staff received good levels of training and support and treated people with kindness and respect. People told us they were well looked after.

Staff respected people’s right to make choices and knew how to support them in this. People received a nutritious diet and found the food enjoyable although some people did have to wait long periods for their meals to be served to them.

Care planning had improved since our last inspection and plans were in place for further development.

Activities were provided but these were not at a level which would meet the needs of all the people living at the home.

Robust processes were in place for auditing the quality of service provision.

We found some confidential records had been left out in a room identified as ‘Residents Lounge’ but was being used by staff as an office. We spoke with the nominated individual about this who said they would immediately make sure that confidential records were kept securely.

Silverline Care Limited is registered as the provider for Manorcroft. At the time of this inspection the day to day management responsibilities were discharged to Orchard Care Homes Limited (previous registered provider) through a Management Agreement.

The inspection visit was carried out by two inspectors. During the inspection, we spoke with the chief operating officer of Silverline Care Ltd, the operations manager of Orchard Care Homes.com Ltd; two nurses and seven people who lived at the home. Not all of the people spoken with during the inspection were able, due to complex care needs, to tell us about their experience of living at the home. We also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

Prior to the inspection we received concerns regarding the care and welfare of people living at the home. We were told people were being nursed in bed due to low staffing levels. During our visit we found evidence which partially substantiated the concerns we received.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. We saw that people’s care records contained care plans which provided staff with clear guidance on how to meet the person’s needs. However, the provider had failed to take appropriate action where issues were identified which impacted on peoples' care, safety and welfare. We have asked the provider to make improvements. Staff were not available to meet people’s care needs appropriately.

Is the service effective?

We looked at five people’s care records. We saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs. On the day of the inspection 23 people were being nursed in bed with bed rails in place. We could not find evidence in care plans about why people were being nursed in bed. People did not receive the support they needed to maintain good nutrition and hydration.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. However, when we spoke with staff about people who lived at the home we found they referred to people by their room number and not their names. People who lived at the home told us the staff were very good, one person said they were completely reliant on them and appreciated them very much.

Is the service responsive?

We saw care records contained evidence to show that people’s needs had been assessed before they moved into the home. Records we looked at contained some details of people’s preferences, interests and life histories. However, we found little evidence of people having opportunity to engage in meaningful activity. When we looked at the documentation in place for the purpose of recording people’s engagement in social activities we found entries on documents which stated “Chatted with whilst giving continence care” “Sleeping” “Watched TV”.

Is the service well-led?

The service was not well-led. Whilst there were systems in place to evaluate care, the assessment and monitoring of the quality of the service provided was not effective. Some of the issues we found during the inspection were long standing but had only been identified by the provider within the three days prior to our inspection. Therefore, people were not routinely protected against the risks of inappropriate or unsafe care. This was particularly in relation to the environments in which support was provided, staffing levels, record keeping and provision of activities to meet people’s social needs. We spoke with the chief operating officer of Silverline Care Ltd and the operations manager of Orchard Care Homes.com Ltd who told us there had not been manager in post for approximately four months. Recruitment was ongoing at the time of our inspection. We spoke with a nurse who told us they felt unsupported and “left to get on with it” during this period of time. We saw the home had high agency staff use to cover vacancies within the nursing team.

The chief operating officer told us that they had identified many of the concerns raised during their current visit and assured us they were taking immediate action.