Manor Court

Manor Court is a residential service providing personal care in one adapted building. The service provides support to older people some of whom are living with dementia. The service is registered to support a maximum of 37 people. There were 22 people living at the service at the time of the inspection. Each person had their own room with a kitchenette and en-suite bathroom.

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

People told us they felt safe living at Manor Court because staff were aware of their safeguarding responsibilities and knew how to report any concerns. Risks to people had been assessed, reviewed and managed to ensure people received safe care. Staff followed infection control guidance and had access to Personal Protective Equipment (PPE).

There were adequate numbers of staff available to meet people’s needs and robust recruitment and selection processes were in place to ensure staff were suitable to work with people.

People said staff were kind and caring in their approach and staff respected people’s privacy and dignity as well as promoting their independence. 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.

People and their relatives were asked for their views about the quality of the care delivered at the service through surveys and meetings. People had access to healthcare services when required to meet their needs.

Regular audits were completed by the management team to check the safety and quality of the service delivered. This included competency checks of staff practice.

We have made a recommendation about the management of some medicines.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was outstanding (published 5 December 2017.)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Manor Court is a residential service providing care without nursing. Nursing services are provided by the community nursing teams. Residential care is provided for up to 37 older people, some living with dementia. On the day we inspected, 36 people were living at the service. High quality accommodation and facilities were provided. Each person had their own room with a kitchenette and ensuite bathroom facilities.

At the last inspection in June 2015, the service was rated Good. At this inspection we found under the leadership of a new registered manager the service had continued to develop and improve and we have rated the well-led and caring section as Outstanding.

The service had a new 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 service was exceptionally well-led. The registered manager led a visible, committed, caring team to provide excellent, holistic care. There was a focus on continuous improvement to enhance people’s lives. New research initiatives in dementia care were being continually implemented for the benefit of people for example programmes such as Anchor Inspires, Oomph! and the Archie Project. These supported people to remain mentally and physically active.

People, relatives and professionals described the provider and management team in a particularly positive way. During the inspection, people and staff were relaxed, and there was a calm, quiet atmosphere. We observed staff chatting with people and making them feel special. Everybody had a clear role within the service.

People’s voices were listened to and ideas implemented for example a special black tie evening had been held with old style card games for the gentlemen. Staff were confident to speak out and ask for anything they needed to deliver high quality care for example additional training or new equipment. We were told the registered manager, deputy and staff were a role model to others. This had led to a change in culture at the service over the past 12 months. Everyone we spoke with told us the leadership team were supportive and approachable. This had resulted in high staff morale and high satisfaction amongst people and families. Staff talked positively about their jobs and their love of the people living in the home. All staff we spoke with were proud of the excellent care people received. Staff told us it met the “Mum Test.” The provider’s district manager supported the service and registered managers.

Feedback we received about end of life care was exceptional. Countless letters from families described how compassionate staff supported people and their families throughout the whole process. Families were able to stay at the service during someone’s last days and staff did all they could to meet people’s final wishes.

Staff exhibited an exceptionally kind and compassionate attitude towards people. Staff were mindful of equality and diversity and respected people. Positive, caring relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity and individual behaviours. Feedback we received from people, relatives and professionals was excellent.

People’s risks were managed well and monitored. Positive risk taking was encouraged to support people’s independence. The environment supported people living with dementia with spacious lounges, visual stimulation and dementia friendly lifts. People were promoted and encouraged to live full and active lives and we observed many enjoy an exercise session. An old style sweet shop was being made in the garden during the inspection for people to enjoy.

There were comprehensive quality assurance systems in place. These were analysed and used to improve practice. Incidents such as falls were appropriately recorded and analysed for trends for example times of day a fall occurred and where within the service. Learning from incidents, concerns and feedback raised was used to help drive improvements. The staff team were reflective and listened to advice from professionals for example local safeguarding training had been suggested (in addition to the providers training) and this had been actioned. Inspection feedback was also listened to and reflected upon which further enhanced the quality of care. For example some staff felt they would benefit from face to face Mental Capacity Act training and this has been arranged. During the inspection information we requested was supplied promptly, records were organised, clear, easy to follow and comprehensive.

People were comfortable with staff supporting them and we observed very positive, attentive and caring interactions throughout the two days. Care records were personalised and gave people control over aspects of their lives. Staff responded quickly when they noted changes to people’s mental or physical well-being by contacting the appropriate health professionals, for example people’s doctor. People or where appropriate those who mattered to them, were involved in discussing people’s care needs and how they would like to be supported. People’s preferences for care and treatment were identified and respected.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, mental health nurses, social workers, occupational therapists and physiotherapists.

People told us they felt safe and secure at Manor Court. Security at the service was good, equipment was maintained and regular fire checks were undertaken. An ongoing maintenance schedule was in place with planned work being undertaken. Anchor Trust is a non-profit provider which enabled continual investment in the service for the benefit of people, for example ensuite facilities were being replaced.

Areas were uncluttered and clear for people to move freely around the home. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge about how to report any concerns and described what action they would take to protect people against harm. Staff all knew the whistleblowing policy and would have no hesitation to raise concerns.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005). This ensured people were involved in decisions about their care and their human and legal rights were respected. The service followed the processes which were in place which protected people’s human rights and liberty.

People were supported by a staff team that had received a comprehensive induction programme, training, which included supporting people with dementia, and ongoing support from the registered manager. Staff feedback was listened to and additional training provided where required.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. People were involved in choosing who worked at the home. Recruitment was value based to ensure the staff employed were kind, caring and compassionate.

The service had a policy and procedure in place for dealing with any concerns or complaints; we reviewed one complaint and discussed this with the registered manager. An open door policy supported people to raise any small concerns early.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences. One relative said, 'The staff have been so helpful".

Staff were clear about the actions they would take should they have any concerns about people's safety.

We looked at care records for three people. We spoke to staff about the care given, looked at records related to them, met with them and observed staff working with them. Both visiting health professionals we spoke with confirmed that the staff at the home were helpful by assisting them with people.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity was assessed to determine if they were able to make particular decisions about there lives.

As part of the quality monitoring system, people who lived in Manor Court were sent surveys to complete. These surveys asked their views of the home to show that peoples view were important to Anchor Care.

We saw that staff did not always treat people with respect and people were left for long periods without any interaction.

One person living in the home told us that they had to wait so long for a call bell response from staff that they were incontinent which caused them great upset and embarrassment.

We saw people's food and fluid charts not being completed, even after a reminder by us, on the first day of our visit. Urine output charts were not completed as requested.

Care plans were not completed or updated and did not reflect people health and social care needs. This means that people's care needs may not have been met.

We found that some of the care plans had not been signed by the person concerned even though they had capacity to do so. This means the person receiving care has not agreed to their plan of care.

One person said the home had, 'Not enough staff'. One staff said, 'We never have time to talk to people' and there was 'No management support'.

We had received concerning information about people's needs not being met in a timely way possibly due to low staffing levels. During our visit we saw this appeared to be the case, the home did not currently have a manager in place taking charge of the home and monitoring staffing levels.