The inspection took place on 29 January 2019 and was unannounced.

About the service: Manor Court is a residential care home that provides personal and nursing care for up to 111 people. The service is divided into four units. Three units are for older people and one unit is for younger adults with physical disabilities. At the time of our inspection 82 people were living at the service, 23 were younger adults. Some of the older people were living with the experience of dementia. The service included four residential buildings on one site. Each building made up one unit, which was self-contained with its own communal facilities. Beech and Larch units provided accommodation for people who were living with the experience of dementia. Willow unit provided accommodation for older people. Sycamore unit provided accommodation for younger adults with physical disabilities. Some people also had learning disabilities.

People’s experience of using this service:

¿ People were not always being safely cared for. They were placed at risk of harm and abuse because there were not enough preventative measures taken to keep them safe.

¿ The risks to their safety and wellbeing had not always been assessed or planned for. This meant that the staff did not have the information they needed to mitigate risks and keep people safe.

¿ Medicines were not always managed in a safe way and this meant people were at risk of not receiving the medicines they needed safely.

¿ There were not always enough suitable staff deployed to meet people's needs and keep them safe.

¿ The provider's systems for monitoring and improving the quality of the service had not been effective, because people were not always receiving a good quality of service and risks had not been mitigated.

¿ Records were not always accurately maintained or up to date. This meant that people were at risk of receiving care which was not appropriate.

¿ The provider did not always act in accordance with the Mental Capacity Act 2005. Therefore, people had not consented to their care and treatment and decisions had not always been made in their best interests.

¿ People did not always receive personalised care which reflected their needs and preferences

¿ Some people using the service were happy and experienced kind care and support.

¿ People had access to healthcare services and the staff worked with other professionals to make sure people stayed healthy.

¿ People had enough to eat and drink.

¿ People being cared for at the end of their lives received the support and care they needed.

Rating at last inspection: The last inspection took place on 26 June 2018. At this inspection we rated the service good overall and for all of the key questions we ask.

Why we inspected: We carried out our inspection of 29 January 2019 because we had been alerted to concerns about the service. These included medicines errors, unexplained injuries and other safeguarding concerns. The local authorities who commissioned services with the provider and who carried out safeguarding investigations, had shared their concerns about the service with us.

Enforcement: We are taking action against the provider for failing to meet Regulations. Full information about CQC's regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in l

We undertook an unannounced comprehensive inspection of Manor Court Care Home on 26 and 27 June 2018. As part of our inspection we checked that improvements to meet legal requirements planned by the provider after our focused inspection on 4 and 5 December 2017 had been made, which we found they had.

Manor Court Care Centre is a '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.

Manor Court Care Centre accommodates 111 people across four separate units, each of which had separate adapted facilities. Three units were open at the time of the inspection. One of the units catered for people living with the experience of dementia, the second unit was for younger adults with a physical disability and the third unit accommodated older people and those who required end of life care. At the time of inspection one unit was closed and there were 73 people accommodated over the other three units.

The service is required to have a registered manager and there was one 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.

Since our last inspection there had been significant improvements made with the auditing and monitoring of the quality of the service. Quality assurance systems were robust and being used effectively so shortfalls were being identified and addressed in a timely way. Record keeping had improved and we also found that people were receiving the care and support they wanted. Work was ongoing to identify further improvements.

People said they felt safe living at the service. Staff understood the procedures to follow to protect people from the risk of abuse and to report any concerns. Risks for individuals and for the service were assessed and action taken to minimise them. Systems and equipment were checked, maintained and serviced at the required intervals to keep them in good working order.

Staff recruitment procedures were in place and being followed to ensure only suitable staff were employed. There were enough staff available to meet people's needs and staffing levels were kept under review in line with changes in people’s needs.

Medicines were being managed safely at the service. Infection control procedures were in place and being followed. The registered manager used reflective practice to consider all aspects of the service including events so where shortfalls were identified lessons could be learnt.

People were assessed prior to coming to the service to identify their needs and wishes, which were recorded and were being met. Staff undertook induction training programmes and received ongoing training to provide them with the skills and knowledge to provide good care and support.

People's dietary needs and preferences, including those to meet people's religious and cultural needs, were being identified and met and a range of meals were provided. People were referred to healthcare professionals when needed and received the healthcare input they required.

The environment provided a homely place to live and each unit was appropriately decorated and furnished to meet the needs of the people who lived there.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). People were encouraged to have choice and control of their lives and staff supported them in the least restrictive way possible.

People and relatives were happy with the care and support people received. Staff treated people in a caring and gentle manner, with dignity and respect. Staff understood and respected

We undertook an unannounced focused inspection of Manor Court Care Centre on 4 and 5 December 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 18, 19 and 24 July 2017 comprehensive inspection had been made. The team inspected the service against three of the five questions we ask about services: is the service safe? is the service responsive? and is the service well led? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Manor Court Care Centre is a ‘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.

Manor Court Care Centre accommodates 111 people across four separate units, each of which had separate adapted facilities. Three units were open at the time of the inspection. One of the units catered for people living with dementia, the second unit was for younger adults with a physical disability and the third unit accommodated older people and also those who required palliative care. At the time of inspection one unit was closed and there were 63 people accommodated over the other three units.

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.

People did not always receive the personal care they wanted and care records were not always up to date and/or accurate. Although auditing and monitoring processes were in place and being followed, action plans did not address all the shortfalls that had been identified, so were not effective in making sure areas identified for improvements were addressed. You can see what action we told the provider to take at the back of the full version of the report.

Since our last inspection, there had been improvements made with the completion of staff recruitment records, however auditing processes needed to be robust to ensure full compliance with the provider’s own recruitment procedures. Risk assessments for individuals and for systems, equipment and safe working practices were in place and identified the action to take to mitigate the risks. The provider made suitable arrangements to ensure people were protected against the risks associated with the inappropriate administration of medicines. Staff understood and followed safeguarding procedures. People and relatives felt people were safe living at the service. Processes were being followed to learn from incidents.

Staff were responsive to people’s needs although improvements with the activities provision at the service had been identified and were still in the process of being implemented. The provider had sought specialist advice and input to improve dementia care awareness among the staff, which had been partly effective, with more work required with the activities provision. There was a complaints procedure in place and this was being followed. People’s wishes in respect of end of life care were discussed and recorded.

Improvements were needed with recording and addressing feedback, for example, listening to people’s personal care needs and taking action to ensure any issues were being addressed. The service had several members of the management team and people and relatives were not all clear about who was in ch

The last inspection took place on 11 October 2016 when we found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to person centred care, dignity and respect and safe care and treatment. At this inspection we found improvements had been made in all these areas. However, shortfalls were identified with risk management and with recruitment records and the monitoring processes were not robust enough to have picked these up.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 111 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, including those who require palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back into their homes. People living there were able to stay at the home for up to six weeks. At the time of our inspection 84 people were living at the home.

The service is required a registered manager in post but did not have one at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The previous registered manager had left the service and a new manager had been in post since January 2017 and has applied to register with CQC.

Individual risks to people were assessed, however management plans to identify the action to be taken to minimise them were not always available. Risk assessments for equipment and safe working practices were not available in areas where equipment was being used. In many instances medicines were being managed safely but we identified a few instances where further attention to detail was needed to ensure they were always managed safely. The provider did not ensure that staff recruitment procedures were always followed to ensure only suitable staff were employed by the service. The processes for auditing and monitoring the quality and safety of services people received had not always been effective in identifying shortfalls within the service.

Systems and equipment were being serviced and maintained and incidents and accidents were recorded, investigated and monitored to minimise the risk of recurrence. Procedures were in place to safeguard people against the risk of abuse. Staff knew to keep people safe and to report any concerns.

Infection control procedures being followed to maintain a clean environment and protect people from the risk of infection.

There were enough staff on duty to meet people’s needs. Staff received training to provide them with the skills and knowledge to care for people effectively. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). Authorisations under DoLS were in place where required to ensure that people’s freedom was not unduly restricted.

People’s dietary needs and preferences were identified and met. People’s healthcare needs were recorded and they received the input from healthcare professionals as they required.

People were asked about the care and support they wanted to receive and said this was respected. Staff treated people with respect and cared for them in a kind and gentle way.

Care records were comprehensive and identified people’s needs and how to meet them. Daily records did not always reflect if people wer

The inspection took place on 11 October 2016 and was unannounced.

The last inspection took place 24 November 2015 when we found breaches of three Regulations relating to consent to care and treatment, person centred care and good governance. At this inspection we found improvements had been made in all these areas. However, people living in one part of the service did not received personalised care and therefore the requirement to meet this breach had not been met.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 111 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, some who are receiving palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit was opened in 2015 and is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back home. People living there were able to stay at the home for up to six weeks. At the time of our inspection 82 people were living at the home.

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 and associated Regulations about how the service is run.

Parts of the building were not safe or clean and this meant people were at risk. In addition the environment did not always suit their needs or ensure their privacy was respected.

People living on Sycamore unit did not receive care which reflected their preferences and individual needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Most people living at the service were happy there and their needs were met. In particular people living in Beech unit received care which was personalised and reflected their individual needs and preferences. They were supported to learn new skills and to achieve personal goals which they had been part of developing. People living in Willow unit and Larch unit also received care which met their needs. Where possible they had been consulted about this and had consented to their care. The provision of social activities had improved on these units and people were able to participate in a range of events which were designed to interest them.

Families of people living at the service felt involved with the care of their loved ones. They were welcomed at the home and able to assist people if this is what they wanted. They told us they were informed about the care of their relative and were happy with the care provided.

The staff felt well supported and had the training and information they needed to care for people. There were enough staff and they were suitably employed. There were clear lines of responsibility and managers were available and accessible.

There were thorough systems for auditing the service and the care people received. These included regular checks on people's safety and wellbeing by the staff and senior managers within the organisation. Records were clear, up to date and well organised, with the exception of a small number of care plans which had some contradictory information. People received medicines in a safe way, and there were robust systems for ensuring medicines were safely managed. People were able to make complaints and felt these were listened to and acted upon.

The inspection took place on 24 November 2015 and was unannounced.

The last inspection of the service was on 19 May 2015 when we found breaches of Regulation relating to the management of the service, safe care and treatment, need for consent, person centred care and good governance. At this inspection we looked at whether these breaches had been met. Improvements had been made in all areas, although there were still some breaches of Regulation because there were not enough improvements in the way in which people’s consent was obtained and how their social needs were met.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 120 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, some who are receiving palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit was opened earlier in 2015 and is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back home. People living here are able to stay at the home for up to six weeks. At the time of our inspection 75 people were living at the home.

There was a manager in post. They had applied to be registered with the Care Quality Commission and were waiting for confirmation of their registration. 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 and associated Regulations about how the service is run.

Improvements had been made to the assessment of people’s mental capacity and recording their consent. However, these were not enough. Some people’s capacity had not been accurately assessed and information about this was not clear. Whilst some people had been asked to give recorded consent to their care and treatment, others had not and there was no, or limited information to show whether they consented to their care.

People did not always have the opportunity to take part in social activities which met their needs and reflected their preferences.

There were not always accurate, complete and contemporaneous records of the care planned and provided to each person.

Risks to people’s safety and wellbeing had been assessed and were being managed. The concerns identified at the last inspection had been addressed.

People’s medicines are managed so that they are received safely, with minimal risk of harm.

The provider had procedures to safeguarding people and the staff were aware of these and followed them.

There were enough staff to keep people safe and the recruitment procedures were designed to check staff suitability to work with vulnerable people.

Parts of the environment looked worn and were not thoroughly cleaned. However, the provider had a plan to address these, including the replacement of malodourous carpets. Other areas of the building were clean and well maintained.

The staff received the support and training they needed to care for people.

People’s healthcare needs were assessed, recorded and monitored. They had access to a range of healthcare professionals

People’s nutritional needs were met and their preferences and needs were recorded. However, people did not always feel the timings of meals met their needs.

People told us the staff were kind, caring and polite. We observed this, although some of the staff were focussed on the task they were performing and did not always explain what they were doing to people.

People’s privacy and dignity were respected.

People’s needs were assessed. Care and treatment were plann

The inspection took place on 19 May 2015 and was unannounced. We last inspected the service on 13 May 2014 and found there were no breaches of Regulation.

Manor Court Nursing Home is owned and managed by Bupa Care Homes (CFHCare) Limited (BUPA). The home is registered to provide accommodation, personal and nursing care to up to 120 people. The home is divided into four units, each unit catering for people with different needs. Larch unit is for older people who have dementia; Willow unit caters for older people, some who are receiving palliative care. Sycamore unit is for younger adults (people under 65 years) who have a physical disability. Beech unit was opened earlier in 2015 and is commissioned by the local Clinical Commissioning Group to provide care, support and rehabilitation to people who are recovering from an injury or illness and hoping to move back home. People living on Beech unit were able to stay at the home for up to six weeks. At the time of our inspection 84 people were living at the home.

The registered manager left the service in 2014. The organisation appointed a new manager who has been in post since this time. They had not applied for registration with the Care Quality Commission. During the inspection they informed us they were leaving the service. A temporary manager had been appointed to manage the service for three months whilst a replacement was recruited. This person was at the service on the day of 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 and associated Regulations about how the service is run.

The units of the home were managed independently of each other and catered for people with different needs. The quality of care varied between the units.

Some of the practices we observed put people at risk. In particular we observed people being supported to eat and drink in a way which meant they were at risk of choking.

People were at risk because their medicines were not always managed in a safe way.

Some people had their liberties restricted in an unlawful way. For example, through the administration of sedative and covert (without the person’s knowledge) medicines.

People’s capacity to make decisions about their care and treatment had not always been assessed. Their consent to care had not always been obtained.

People living on Willow unit did not always receive care which was personalised and respected their dignity. The staff were sometimes too busy to listen to people’s requests and respond to these.

The provider had systems to monitor the quality of the service and these were comprehensive. Some of these had identified areas of concern. However, the risks to people’s well-being and safety had not been appropriately managed.

People’s recreational and social needs were not always met in the same way throughout the home. In some units people wanted more opportunities for social activities and wanted their individual choices and preferences to be taken into account. In other units people felt their social needs were met.

The provider employed enough staff but they did not always deploy these in a way so that everyone living at the home had the same experience of support and attention.

The provider had procedures to help identify abuse and the staff had been trained in these. The provider had taken appropriate action and liaised with other agencies to investigate safeguarding concerns.

The provider made appropriate checks on the suitability of staff before they started working at the service.

People’s nutritional needs had been assessed and they were given the support they needed to meet these. They were offered a variety of fresh and well prepared food.

People’s health, physical and nursing needs had been assessed and the staff worked with other professionals to meet these.

The staff had the support and training they needed to care for people.

Some people told us the staff were kind, caring and attentive. They had good relationships with the staff and felt the staff had time to talk to them as well as attend to their personal and healthcare needs.

People’s privacy was respected.

People’s health and personal care needs had been assessed and recorded. Although there was no record of some people’s preferences regarding their care.

There was an appropriate complaints procedure which the provider followed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLs). DoLS provides a process to make sure that providers only deprive people of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The provider had sought appropriate authorisation for the deprivations of liberty which they had assessed and considered to be in people’s best interest.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

You can see what action we told the provider to take at the back of the full version of the report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

People were cared for in a suitable and safe environment. Their needs were recorded in individual care plans and there were checks to ensure these needs were being met. Any risks to people’s safety and wellbeing had been assessed and action had been taken to reduce the risk of harm. People’s medicines were appropriately stored, recorded and administered. The staff were well trained and supervised to make sure they cared for people safely. One visitor told us the home kept people safe and they felt comfortable and relaxed leaving their relative in the care of the staff.

Is the service effective?

People’s health and personal care needs were met. Their individual needs had been assessed and recorded. They had access to their GP whenever they needed. The home catered for a range of different needs. Older people living at the home had opportunities to take part in different leisure and social activities. However, younger people who had a physical disability did not always have access to the stimulation and support they needed to improve their health and wellbeing. Although their care was coordinated by an appropriate healthcare professional, there were not always the resources or availability of other healthcare professionals to meet their individual needs. People living at the home and their relatives told us they were happy there and they felt their needs were met.

Is the service caring?

People living at the home and their visitors told us the service was caring. They said they had the things they needed and they were cared for in the way they wanted. The staff were kind and caring towards people, listening to them and respecting their choices.

Is the service responsive?

People’s needs were assessed and changes in their needs were acted upon. There were systems to monitor individual wellbeing and these were well used. Where people had become unwell we saw appropriate action had been taken. People were able to make choices about their care and the staff responded appropriately to these. Where problems had been identified by the provider themselves, others or from CQC inspections action had been taken to address these problems and improvements to the service had been made.

Is the service well-led?

The staff working at the home told us they were well supported by their manager and had clear information and guidance. There were systems to monitor the quality of the service. We saw these had been used to identify areas of concern and to make improvements.

We inspected the service on 9 August 2013 and found that people's needs were not always being met. The provider told us that they would make the necessary improvements by the end of December 2013. In January 2014 the provider contacted us to tell us that they felt they had made improvements at the home and that they were now meeting people's needs. We carried out this inspection to look specifically at this area. However, during our visit we found that people were not always being treated with dignity and respect.

We spoke with five people who lived at the home. They told us that they liked living there. They said they were well cared for and they were able to do the things they wanted to. We spoke with one relative who was visiting. They said they thought the home had a ''lovely atmosphere''. They said they were happy with the care and treatment their relative received and were pleased with the support the staff gave.

We found that in general people's care needs had been identified and were being met. The provider had made improvements to the social activities on offer. They had also employed some specialist staff, offered more training to care staff and had plans for further improvements in meeting people's needs.

However, we saw that the staff did not always show respect to people living at the home. They did not always offer people choices or listen to the choices that they had made.

We observed medicines given to five people and saw that nurses were professional and patient and explained the medicines that they were giving. One person told us that they could not give themselves a daily injection and they liked the way the nurses came to take a blood test and then given the injection. Another person told us that they did not have any pain because nurses brought pain relief when they needed it.

People using the service told us that they were generally happy in the home. They said that staff were available to assist and help them with all aspects of their care. People said that there was a good choice of food available and that they had enough to eat and drink.

They said they could talk to staff if they had concerns and both people and relatives told us that staff were helpful, kind and supportive.

We spoke with eight people who use the service, looked at 12 people's records and spoke with six members of staff and the manager. People we spoke to talked positively about the service. One person said " I like the new physical disability unit, the people are my own age group and the staff are nice." Another person told us “I am just new here and you can't fault anything, they do a good job at caring for us". Some people spoke about the food and people made comments such as "the food is good, there are lots of cultures of people here so I get to try different things." Another person told us " I wish I had more people to chat too many of the people here don't understand me”.

We asked the provider to make improvements following our last inspection on the 16 and 20 February 2013 because arrangements in place for obtaining people's consent to their care and treatment were not adequate. The provider sent us and action plan detailing how improvements would be made. We found people's care records had been reviewed and people's care was planned with their consent, or where they were unable to with the consent of relatives and advocates.

We found people's care was planned in relation to physical and healthcare needs. We observed how people were cared for and looked at records relating to people being supported with their communication. We found staff understanding of people's needs where they had difficulties in communicating was poor and required improvement. We also found that best practices regarding caring for people with dementia and Alzheimer’s condition not always followed.

We looked at medication arrangements and found that people were given their medication by appropriately skilled and trained staff and appropriate audits and recording keeping was carried out to ensure people received their medication safely.

We looked at staff recruitment and found that there were appropriate arrangements in place to ensure staff employed to work in the home had sufficient skills and competencies.