This inspection took place on 13 and 15 November 2018. The first day was unannounced which meant the service did not know we were coming. The second day was by arrangement.

Manorhey Care Centre (Manorhey) is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Manorhey is a modern purpose-built care home and accommodation is provided over three floors and the building is fully accessible. The ground floor unit specialises in providing care to people living with dementia and memory problems; the first floor specialises in providing nursing care; and the second floor provides residential care. The service is registered with CQC to accommodate a maximum of 83 people. At the time of this inspection, 80 people were living at Manorhey.

We last inspected Manorhey in March 2018. At that inspection we found serious continued breaches of regulations associated with the Health and Social Care Act (Regulated Activities) Regulations 2014. As a result, the service was rated ‘Inadequate’ and placed in special measures. This inspection was planned to check whether the provider was now meeting legal requirements.

At this inspection, we found good progress had been made in many aspects of the service. However, further improvements were needed in relation to medicines management and good governance. Despite this, we were satisfied the home had made the necessary improvements overall to be removed from the special measures framework. You can see what action we have taken at the back of the full report.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

At this inspection a medicines inspector (pharmacist) looked at medicines and records for 15 people. We found improvements had been made which meant that people no longer ran out of their medicines and people who needed their fluids thickened could have drinks safely without choking. However, there were still areas of medicine’s management that must be improved to ensure people’s health is consistently protected.

Aspects of governance were not being operated effectively and had failed to identify errors. This was of concern given that the providers own Service Improvement Plan (SIP) was not reflective of current practice for medicines management and that internal auditors have failed to identify these issues.

Following our inspection visit, the provider voluntarily sent CQC an action plan which addressed the areas of concern raised during the inspection. Furthermore, we took into account the fact that since our last inspection, a new registered manager and a new clinical lead were now in post, and, additional medicines management support was being provided by the local NHS Clinical Commissioning Group (CCG).

People had individual assessments in place which identified risks in relation to their health, independence and wellbeing. There were assessments in place which considered the individual risks to people such as mobility, nutrition and hydration, and personal care.

Accidents, incidents and untoward events were recorded and managed appropriately. there was clear information detailing any remedial action taken in order to reduce the likelihood of such events occurring again in the future.

We reviewed staffing levels and noted the providers ongoing recruitment strategy to recruit and retain permeant staff with the aim of reducing the use of agency staffing. Through our own observations of how care was being provided, we found people's needs w

The inspection took place on 13 and 14 March 2018 and it was unannounced.

At the previous inspection in December 2016 we found breaches of legal requirements in relation to notifications of incidents, evidence of seeking consent to care appropriately, person centred care, professional development of staff and evidence to verify equipment maintained in line with manufacturers’ guidelines and governance systems.

Following our last inspection (December 2016), we asked the provider to complete an action plan, which they submitted in April 2017, to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well Led to at least good. At this inspection, we noted improvements had been made in relation to submitting notifications, staff development and providing person centred care. However at this inspection, we found continued breaches of the regulation regarding the need for consent, equipment maintenance and good governance and significant concerns relating to the safe management of medicines. Further information about these concerns can be found in the relevant key question sections of this report.

Manorhey Care Centre (Manorhey) 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.

Manorhey accommodates 83 people across three floors. The ground floor unit specialises in providing care to people living with dementia, the first floor specialises in providing nursing care and the second floor provides residential care. At the time of this inspection there were 80 people living at the care centre.

There was a manager in post who had been registered with the Care Quality Commission since May 2015. 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 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 line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations

We inspected Manor Hey Care Centre on 15 and 19 December 2016 and the first day of our inspection was unannounced. This meant the provider and staff did not know we were visiting. Manor Hey Care Centre (Manor Hey) provides nursing and personal care for up to 83 older people, some of whom were living with dementia. At the time of this inspection there were 81 people living at the care centre. Manor Hey is a large purpose-built three storey building located in Urmston, Manchester and is situated near local amenities such as shops and public transport links. The home has undergone several changes to create an environment that effectively meets the needs of people living with dementia and promotes independence and well-being. Manor Hey also has a well maintained accessible garden with seating areas.

The previous inspection took place in October 2014 and the overall rating for the service was ‘Good.’ The service had a registered manager who had been in post since May 2015. 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 2008 and associated Regulations about how the service is run.

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

We made a recommendation that the service should consider options to improve the dining areas as this would improve the lives of people living at Manor Hey.

People and their relatives told us the care home provided a safe and friendly environment in which to live. All staff had been trained in safeguarding principles and knew what to do if they saw abuse occurring.

Fire drills were undertaken and we saw that a revised recording procedure was due to be implemented. This would help to ensure any actions resulting from fire drills were appropriately addressed to ensure people’s safety at the home.

We found some discrepancies in how medication was recorded on each floor of the care home. During our inspection, we observed that medicines were administered safely to people.

Manor Hey did not always work within the principles of the Mental Capacity Act 2005 (MCA). We found instances where relatives had signed care records on behalf of people but without appropriate authorisation such as lasting power of attorney. This meant that people could be receiving care or support where consent had not been obtained in the correct way.

Staff undertook induction and mandatory training and shadowed experienced staff before working unsupervised. This meant that staff should have the right skills to support people effectively and safely. Staff supervision and appraisals needed to be more consistently scheduled. This would give staff the appropriate forum to discuss service specific issues and help them improve outcomes for people living at Manor Hey.

People commented that the food at the care home was “really good” and we saw this was well presented and a choice of nutritious meals given at all times. We saw that diets were prepared to accommodate people’s specific health conditions or religious/cultural practices.

People and relatives told us they felt listened to and that staff were caring and respectful. We found however instances where the service did not demonstrate caring and respect for people’s dignity and privacy.

People were encouraged to maintain their independence and staff gave us examples of how they promoted this.

People and relatives knew how to make a complaint or raise concerns and some had done so. We saw that not all complaints were appropriately managed and action taken in response.

Care plans were person-centred and contained details of people’s preferences and interests and identified the support needed to meet their cl