Morley Manor Residential 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 registered to provide care and support for up to 31 people, some of whom are living with dementia. Nursing care is not provided. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. At this inspection there were 24 people living at the home, one of whom was in hospital.

This comprehensive inspection took place on 14 December 2017 and was unannounced. At the last inspection in August 2017 we rated the service as 'Requires Improvement'. Although the provider had made significant improvements and was no longer in breach of the Regulations, we found further improvement was required to make sure new work practices were embedded and sustainable.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Morley Manor Residential Home on our website at www.cqc.org.uk

At this inspection we found further improvements had been made and these had been sustained.

There was 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 felt safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Improvements had been made to the environment to make it safe and this work was planned to continue.

The systems in place to make sure that people were supported to take medicines safely had been improved and were effective.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The registered manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans showed that individual preferences were taken into account. Care plans were up to date and gave clear directions to staff about the support people required to have their needs met. People’s needs were regularly reviewed and appropriate changes were made to the support people received. People were supported to maintain their health and had access to health services if needed.

People were encouraged to follow their interests and take part in a range of activities.

People had opportunities to make comments about the service and how it could be improved. A complaints procedure was in place and people told us they knew how to raise a concern if needed.

The manager had good oversight of the service and ther

This comprehensive inspection took place on 23 August 2017 was unannounced. At the last inspection in January 2017 we rated the service as 'inadequate'. We identified breaches in Regulations 10, 11, 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Morley Manor Residential Home on our website at www.cqc.org.uk

Morley Manor Residential Home is registered to provide care and support for up to 31 people, some of whom are living with dementia. Nursing care is not provided. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. At this inspection there were 24 people at the service.

At this inspection we found the provider had made significant improvements and was no longer in breach of the Regulations. However, further improvement was required to make sure new work practices were embedded and sustainable.

At the time of our inspection, there was not a registered manager in place. However, the manager became registered shortly after the 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 safe at the service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep risks to a minimum. Improvements had been made to the environment to make it safe and this work was planned to continue.

The systems in place to make sure that people were supported to take medicines safely were more robust, but needed further improvement to become safe.

There were a sufficient number of staff on duty to make sure people’s needs were met. Recruitment procedures made sure that staff had the required skills and were of suitable character and background. Staff were supported by a comprehensive training programme and supervisions to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted and they lack capacity to make their own decisions. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were provided with sufficient amounts of food and drink. Where people required support with eating or drinking, this was appropriately provided, taking into account people’s likes and dislikes.

People told us that staff were caring and that their privacy and dignity were respected. Care plans had been rewritten and showed that individual preferences were taken into account. Care plans were up to date and gave clear directions to staff about the support people required to have their needs met. People’s needs were regularly reviewed and appropriate changes were made to the support people received. People were supported to maintain their health and had access to health services if needed.

People were encouraged to follow their interests and take part in a range of activities.

People had opportunities to make comments about the service and how it could be improved. A complaints procedure was in place and people told us they knew how to raise a c

We carried out this inspection on 10 and 12 January 2017. Both visits were unannounced. At our last inspection on 5 May 2016 we rated the service as ‘requires improvement’ and identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not always receive safe care and treatment, people’s capacity to make decisions was not being assessed in accordance with the Mental Capacity Act 2005 and we found there was poor leadership and governance. As the service is rated ‘inadequate’ overall, we placed the service into special measures. This gives the provider six months to make significant improvements, and we informed the provider that if improvements were not made we would take action in line with our enforcement procedures.

At this inspection we found the provider had not made sufficient improvements, and remained in breach of the three regulations identified at the last inspection. In addition we identified further breaches.

Morley Manor is registered to provide care and support for up to 31 people living with dementia. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. There was a manager in post when we inspected. They had not applied to register with us. 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.

We found risks associated with peoples’ care and support was not always robustly assessed. In addition we found there were no environmental risk assessments in place. We had raised this with the provider at our last inspection.

There was a lack of training in place to ensure staff were clear about how to evacuate the building in the event of a fire.

Recruitment of staff was not always carried out safely. We saw some files contained only one or no employment references. We did see checks had been made with the Disclosure and Barring Service, however.

People told us they felt safe, and that staff were present in sufficient numbers to meet people’s needs. We saw the manager used a dependency tool to calculate the numbers of staff required to meet people’s needs, however this was not being used correctly or kept up to date. In addition we found staffing rotas did not always accurately reflect the number of staff on duty.

Most staff we spoke with understood the principles of safeguarding and said they had received training in this area. We saw 15 out of 24 staff had received training, meaning we could not be sure all staff had the knowledge necessary to keep people safe from the risks of abuse.

People’s medicines were managed and stored safely, and we saw records relating to the administration of medicines were up to date and correctly completed. Staff practice with medicines was observed to be good, however we received some conflicting information about whether one person received medicines without their knowledge

We saw the provider had made improvements to the décor of the home, and we saw certificates showing maintenance of fixtures and fitting s was kept up to date. We saw large amounts of people’s clothing waiting in the laundry which had not been returned to people. We found the sink unit in the dining room still required attention relating to cleanliness and repair..

We found people’s capacity to make decisions was still not being assessed in accordance with the Mental Capacity Act 2005. Care plans lacked evidence of best interest decisions and consent to care and support, although people told us they were asked for consent before receiving assistance from staff.

We found levels of training received by staff was often low, and this impacted on their ability to provide effective care for people.

People gave good feedback abo

Our inspection took place on 5 May 2016 and was unannounced. At our last inspection on 30 October 2015 we rated the service as requires improvement and identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always being treated with dignity and respect, medicines were not always managed safely, infection control practices were not always well managed, staffing levels were not planned to meet the care and support needs of people using the service and we found staff were not supported to be effective through planned training, supervision and appraisal. At this inspection we found the provider had made improvements in these areas in line with their action plan.

Morley Manor is registered to provide care and support for up to 31 people living with dementia. Nursing care is not provided. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities. Accommodation is arranged over two floors connected by a lift. There are two communal lounges in use, a dining area and a conservatory. There were 26 people using the service on the day of our visit.

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.

There was an inconsistent approach to documenting and managing risks associated with people’s care and support needs. Some health monitoring systems such as those designed to assist with the management of pressure sores were out of date or not being used effectively.

Some aspects of people’s personal hygiene was not well managed. We saw cloth flannels were used when assisting people to wash their bodies and faces. These were not kept unique to one person or body area. When they were dirty they were sent to laundry and re-used when needed. We asked the provider to stop this practice on the day of our inspection.

We found a fire door was secured with a coded lock to protect people from the risk of falls down the staircase at the other side of the door. Only one member of staff on duty when we arrived knew the code to unlock the door. Three of the four staff on duty when we arrived told us they had not taken part in a fire drill and the fourth said they had not received any evacuation training but had taken part in an evacuation when the fire alarm had been triggered accidentally. Fire extinguisher checks were out of date.

Staff understood their responsibilities in remaining vigilant for and reporting any evidence of abuse. They told us the registered manager would act on what they were told.

We found there were enough staff on duty to meet people’s care and support needs. People who used the service said they were not kept waiting when they needed assistance.

The provider ensured that recruitment of new staff was safe, and we saw evidence checks such as references being taken and checks being made with the Disclosure and Barring Service.

Medicines were managed safely and records were kept up to date. We noted the temperature in the medicines storage room had occasionally risen above the maximum recommended level to ensure the safe storage of medicines, and asked the provider to take action to prevent this happening again.

We found that consideration was not always given to whether people who used the service needed a Deprivation of Liberty Safeguard. We found a lack of structure in the approach to assessing people’s capacity to make decisions, and evidence that staff did not always understand these processes thoroughly.

Staff files showed there was an induction programme in place; however staff were not always confident this had been thorough. Staff we spoke with told us many of the assessments to measure their c

This inspection took place on 29 October 2015 and was unannounced. At the last inspection on 30 July 2014 the service was compliant with the regulations we looked at, however we noted concerns with a lack of documentation to show how staffing levels were decided, mental capacity assessments and medication record keeping.

Morley Manor Residential Home is situated on the outskirts of Morley, within reach of the town centre and local amenities. It is registered to provide care and support for 31 people living with dementia. There were 23 people living at the home when we visited. The accommodation for people is arranged over two floors linked by a passenger lift.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

The registered manager had no system in place to ensure there were sufficient staff to meet people’s needs. We saw staff were rushed and under pressure and people were often left waiting for assistance.

The premises were not sufficiently well cleaned and some people did not have hot water in their bathrooms, meaning that infection control practices in the home were not sufficiently robust to protect people from the risk of infection.

Medicines were not always managed safely. We saw medication left unattended and ‘as and when’ medication was not always available when people needed it.

Staff training was inconsistently recorded and the registered manager was unable to locate records of annual appraisals

People told us they found the staff caring and able to meet their needs. Although staff could tell us about ways in which they could protect people’s privacy and dignity we did not always see this in practice.

There was not a meaningful programme of activities in the home.

People told us they felt safe in the home, and staff we spoke with demonstrated understanding of their responsibilities around safeguarding vulnerable people. Records of training carried out in safeguarding were incomplete.

Recruitment practices were robust and the registered manager could demonstrate that appropriate background checks were made to ensure staff were suitable to work with vulnerable people.

Risk was well assessed in people’s care plans.

The service was working within the principles of the Mental Capacity Act 2005 and managing Deprivation of Liberty Safeguards appropriately. Care plans included detail of people’s ability to make decisions and the support they needed to do this when appropriate.

Daily notes were detailed and we saw any accidents or incidents were well recorded and action taken to minimise the risk of these events happening again.

Individual care and support needs were well documented in care plans and we saw evidence of some involvement of people in developing the service.

Concerns and complaints were well managed.

We received inconsistent feedback about the registered manager’s approachability.

There were quality assurance systems in place in the home but these were not always sufficiently robust to ensure they were drivers for improving the quality of the service.

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new process being introduced by CQC which looks at the overall quality of the service

This was an unannounced inspection carried out on the 30 July 2014. At the last inspection in October 2013 we found the provider breached regulations relating to people’s consent to care and treatment, people’s care and welfare and the management of medicine. An action plan was received from the provider which stated they would meet the legal requirements by May 2014. At this inspection we found improvements had been made with regards to these breaches.

The home had a registered manager who had been registered since April 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

Morley Manor Residential Home is registered to provide care and support for up to 31 people living with dementia. There were 15 people living at the home when we visited. The accommodation for people who lived in the home is arranged over two floors linked by a passenger lift. The home is situated on the outskirts of Morley, within reach of the town centre and local amenities.

On the day of our visit we saw people looked well cared for. We saw staff spoke calmly and respectfully to people who lived in the home. Staff demonstrated they knew people’s individual characters, likes and dislikes.

People’s relatives told us their family member felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm.

The care plans we looked at showed the provider had assessed people in relation to their mental capacity. However, we could not see how some decisions had been taken. The registered manager told us they were confident staff would recognise people’s lack of capacity so best interest meetings could be arranged. We saw eight members of staff had completed the Mental Capacity Act (2005) training and there were five more members of staff to complete. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

We found people were cared for, or supported by, sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

We checked how people’s medicines were managed. The medicine management system required improvement.

Suitable arrangements were in place and people were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. Care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. Staff had good relationships with the people living at the home and the atmosphere was happy and relaxed.

We observed interactions between staff and people living in the home and staff were kind and respectful to people when they were supporting them. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

The registered manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager which included action planning. Staff were supported to challenge when they felt there could be improvements and there was an open and honest culture in the home.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Due to the complex needs of people using the service we were unable to speak with many people. To help us understand the experiences of people using the service, we observed the care being provided, spoke with staff and spoke with the relatives of three people who used the service. The three relatives we spoke with were very happy with the care provided by staff. One relative said; “The staff are brilliant. They ring me and keep me informed. I’m involved in the care planning and met with [my relative’s] key worker.” Another relative told us; “The staff are nice. I’m happy with the care.” One relative commented that they had seen a massive improvement with their relative.

We found improvements had been made since the last inspection. For example, new care plan documentation had been introduced and staff were more focused on people’s needs. However, we found there were still areas of non-compliance but because of the improvements made, the risk to people had been reduced. We will continue to monitor this location and to work in partnership with the Local Authority Contracts team and the Local Safeguarding Authority.

We carried out this inspection in response to information of concern we received. The information alleged that: staff did not respond immediately to allegations of abuse; allegations of abuse had not been appropriately reported; and care records did not reflect people’s current needs.

Due to the complex needs of people using the service we were not always able to speak with people. To help us understand the experiences of people using the service, we observed the care being provided, spoke with staff and spoke with the relatives of one person who used the service.

We observed that people appeared clean and dressed appropriately. We saw people were able to wander freely around the home. One relative told us; “My [relative] is settled here. The staff are absolutely brilliant. They show so much care and keep me informed.”

We looked at three care records and found care plans were very basic and lacked sufficient detail to show how a person wished to be cared for. We found that where people did not have the capacity to consent, the provider did not act in accordance with legal requirements.

We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We found evidence that the provider had not notified the CQC of incidents that had occurred within the home. This included safeguarding incidents, which had not been referred on to other appropriate agencies.

We spoke with five people who lived at the service, they told us they were happy and comfortable living at the home and that they got the care and support they needed.

People we spoke with told us they received care that was appropriate to their needs. One person told us "Staff are nice; I can do as I please here."

People living at the home told us their individual needs were met. One person told us "I can get up and go to bed when I like here".

Visitors told us they were involved in making decisions about their relatives care and treatment. They also said they were kept informed of any changes in the needs of their relatives. One person told us "If anything happens they let us know straight away, they keep us well informed."

Staff we spoke with told us they felt supported and had the knowledge and skills to support people who lived at the home. One staff member said "I like coming to work; it is like coming home from home".

Many of the people who use this service could not tell us directly about their care due to their complex needs.

At our inspection of May 2008 these are some of the things people told us,

“People spoke positively about the staff; they said they are treated with respect. Our observations confirmed this.

People said: “The staff support us very well”, “I’m happy with all the staff, they’ve made me feel very welcome and at home

“The staff are very good at communicating with us about the care of mom.”

As part of this review we contacted other healthcare professionals who have had involvement at the service. They told us that they found the service worked well with them:

“very open to suggestions”

“friendly and welcoming”

“not the sort of place you go into and find them all asleep”

“very good at letting me know my patient was in hospital”

“no particular concerns”

“warm and welcoming”

“do follow instructions”

We saw that people were confident and content in their surroundings. They chatted with staff openly and the atmosphere was calm and relaxed. People told us that they were happy at the home and that the staff looked after them well.

At our inspection of May 2008 we noted some of the comments made to us:

‘“Staff do have the right skills, also very caring to the people in Vivian House.

“Nothing is too much for staff when it comes to the care of people in the home. They are very helpful it is not easy but they do it well.” ‘

The provider’s annual quality audit for 2010 included comments made by people about the staff:

“staff are friendly”

“They give us understanding and they are all right to speak to”

Other healthcare professionals spoke well of the staff:

“warm and welcoming”

“impressed” (with their knowledge)

“very open to suggestions”

During our site visit we spoke with staff who told us that they were very well supported by all the management team.

Other healthcare professionals involved in the service told us that they had been given a questionnaire to complete about the service. They had taken the opportunity to raise a concern about odours in the home. Following this the manager had contacted them and the problem had been resolved.