We conducted an announced inspection at SENSE Manor Court on 06 August 2018. We gave the provider advanced notice of our visit because the people who lived there had complex needs and this would enable staff to prepare them for our visit. SENSE Manor Court 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.

SENSE Manor Court is registered to provide accommodation and personal care for five people who have a learning disability and/or a sensory disability. At the time of our inspection visit there were five people living in the service.

A registered manager was present during 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 2008 and associated Regulations about how the service is run.

During the home’s previous inspection on 7 July 2017, we rated the home overall as ‘Good’ but improvements were needed in Well Led regarding sending notifications to CQC. During this inspection, we found this improvement had been made but we found some other areas of concern and the overall rating has now changed to ‘Requires Improvement’. The details of the reasons why are explained in the summary below and in the body of the main report.

People were supported by staff who understood the risks they could face and knew how to keep them safe. Most risks to people’s health and safety were identified and action was taken when needed to reduce these, but this was not the case for using the communal grounds. There were not always sufficient or suitably skilled staff on duty to meet people’s needs. Staff underwent appropriate recruitment checks before they commenced their employment. People received their medicines as prescribed although they could be managed more safely. People were being protected from infection because safe practices were being followed.

People were supported by staff who received appropriate training and supervision and had an understanding of their needs. People were supported to make choices and decisions for themselves. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service (do not) support this practice

People had a nutritious diet which met their needs and they were provided with any support they needed to ensure they had enough to eat and drink. Staff understood people’s healthcare needs and their role in supporting them with these. Systems were in place to ensure people lived in a properly that was well maintained.

People were cared for and supported by staff who respected them as individuals. Staff had caring relationships with people and respected their privacy and dignity. People were enabled to express the care they wanted to receive.

The lack of clear care planning meant that people may not receive the care they require. People were encouraged and supported to participate in meaningful interaction and activities. People would be supported to raise any complaints or concerns they had which would be dealt with. People’s end of life wishes were known so that these could be acted upon when needed.

Staff worked well as a team and felt supported with their work by the registered manager. We have made a recommendation about improving the systems in place for auditing and monitoring the service as they were not effective in identifying where improvements were needed.

We carried out this announced inspection on 31 July 2017. We gave the service a short period of notice. This was because the people who lived there had complex needs for care and benefited from knowing in advance that we would be calling.

SENSE – Manor Court is registered to provide accommodation and personal care for five people who have a learning disability and/or a sensory disability. At the time of our inspection visit there were five people living in the service.

The service was run by a charitable body that was the registered provider. 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. In this report when we speak about both the charitable body who ran the service and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 10 July 2015 the service was rated Good.

At this inspection we found the overall quality rating for the service remained Good. However, we found one breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered persons had not as soon as practical told us about two significant events that had occurred in the service. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings were as follows. Care staff knew how to keep people safe from the risk of abuse including financial mistreatment. People had been supported to take reasonable risks while also being helped to avoid preventable accidents. Medicines were safely managed and there were enough care staff on duty. Background checks had been completed before new care staff had been appointed.

Care staff had received training and guidance and they knew how to care for people in the right way. This included knowing how to communicate with people using sign assisted language. People enjoyed their meals and they had been helped to obtain all of the healthcare assistance they needed.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People were treated with compassion and respect. Care staff recognised people’s right to privacy and promoted their dignity. There were arrangements to help people access independent lay advocates if necessary and confidential information was kept private.

People were involved in making decisions about the care they received and they were supported to be as independent as possible. People had been had been helped to pursue their hobbies and interests. There were arrangements for quickly and fairly resolving complaints.

People had been consulted about the development of their home and quality checks had been completed. The registered persons had displayed the ratings we gave the service at our last inspection. Good team work was promoted and care staff were supported to speak out if they had any concerns.

Further information is in the detailed findings below.

This was an announced inspection carried out on 10 July 2015.

There was a 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.

SENSE Manor Court is registered to provide accommodation and care for up to five people who have a learning disability and sensory impairments.

There were five people living in the service at the time of our inspection.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. The safeguards are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to deprive them of their liberty. This is usually to protect themselves. At the time of our inspection the registered persons had consulted with the relevant local authorities who had determined if people were being deprived of their liberty and so needed to have their rights protected.

Staff knew how to recognise and report any concerns so that people were kept safe from harm. People were helped to avoid having accidents and their medicines were safely managed. There were enough staff on duty and background checks had been completed before new staff were appointed.

Staff had received the training and guidance they needed to assist people in the right way including helping them to eat and drink enough. People had received all of the healthcare assistance they needed including dental care. Staff had respected people’s rights because they had correctly used the Mental Capacity Act 2005 Code of Practice. This had ensured that whenever possible people were supported to make decisions for themselves. In addition, staff had used the safeguards in the law to protect people’s rights when decisions needed to be made on their behalf.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy, respected confidential information and promoted people’s dignity.

People had received all of the care they needed including people who had special communication needs or who were at risk of becoming distressed. People had been consulted about the care they wanted to receive and they were supported to express their individuality. Staff had assisted people to pursue a wide range of interests and hobbies. There was a system for resolving complaints.

People had been consulted about the development of the service and regular quality checks had been completed. The service was run in an open and inclusive way and people had benefited from staff receiving good practice guidance.

This summary is based on information we obtained when we visited the service on 23 October 2014. We completed this inspection to check that the provider had made the improvements that we said must be made when we inspected the service on 23 April 2014. At our earlier inspection we found that improvements needed to be made to the way in which people who used the service, their relatives and health and social care professionals were invited to make suggestions about the development of the service.

In addition, we found that there were shortfalls in some of the quality checks completed in relation to the accommodation. This had resulted in a leak in the bathroom not being quickly addressed and in some fire safety improvements not being carried out.

We said that the arrangements used to consult with stakeholders and to complete some quality checks needed to be strengthened. This was necessary to ensure both that people who used the service received the support they needed and that this was provided in a safe setting.

After our inspection dated 23 April 2014 the provider wrote to us and said that it had made the improvements that were necessary to address our concerns.

Our inspection dated 23 October 2014 examined the measures used by the provider to consult with and act upon the suggestions of key stakeholders. In addition, we looked at how effectively the provider was completing quality checks of the accommodation including bathrooms and the fire safety system.

We found that the provider had introduced all of the necessary improvements.

We considered our inspection's findings to answer 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 caring?

People who used the service and their relatives considered staff to be respectful, kind and attentive.

Is the service responsive?

We saw that people's individual needs for support were assessed so that they could be fully met. People were involved in making decisions about the support they received and they were supported to give informed consent whenever possible.

Is the service safe?

Staff had understood their roles and responsibilities to ensure that people were protected from the risk of abuse. People were protected against the use of unlawful or excessive control or restraint because the provider had made suitable arrangements. No one was having their liberty restricted at the time of our inspection visit.

Is the service effective?

We found that staff knew about people's individual personal and healthcare needs. People received the support they needed and wanted.

Is the service well led?

There were shortfalls in the quality assurance system. These oversights reduced the provider’s ability to ensure that people received support in the right way and in a safe setting.

One relative told us care staff did a lot with people who used the service. They said people “Did things which even I have never done”.

Another relative told us their relative “Liked to come home but also liked to go back". "They had peace of mind knowing that they were happy there”.

On the day of our visit only one of the five people who used the service was at home. We met other people using the service later in the day. We were unable to gain people's views because of the different ways people communicated. We spent time observing care, speaking to staff and reviewing records to see what it was like to live at the home.

We saw staff communicated with people by using sign language and pictures. We saw from photographs people were involved in activities ranging from canoeing and horse riding to painting and pottery.

Each person had a support worker responsible for organising what they did on their home days.

People using the service were involved in choosing the meals which were included in the menu plan.

We found there was a high number of incidents of challenging behaviour involving one person. The behaviour assessments we saw had been completed some time ago and there was no action plan to reduce the risk of reoccurrence.

Staff received appraisal, supervision and other forms of support. We saw staff had received training in crisis intervention to help them resolve any problems with disruptive behaviour.

On the day of our visit to the service only two of the five people who lived at Manor Court were at home. The other three people were attending day care services.

Both people who were at home could not communicate verbally with us, however we observed their well being and observed the interactions between the staff and the people who lived there.

We saw staff communicated with people by using sign language. People were given lots of opportunities to make choices and live active lives and be involved in the local community.

The service provided a comfortable and homely environment where the people who lived there were encouraged to be independent.

Most of the staff who worked at the home had been there for a long time and knew about the needs of the people they looked after. They were able to offer them support which was tailored to suit their needs and they recognised when people became upset and offered diversion techniques in order to reduce challenging behaviours.

We spoke with two relatives of the people who lived there. They were complimentary about the service. One parent we spoke with told us, “They are totally and utterly brilliant. The service provided by Sense has given my daughter a life. I can’t think of anyway they could improve.”

Another relative told us, “My son has more than just a life, they give him such choice and opportunity. I go to bed and I go to sleep as I know his welfare and safety is well looked after.”

In view of the communication needs of the people who use the service, we relied on observations between the staff and people who use the service, information provided by the staff and the service provider.

When asked one person told us they liked the work placement they attended on their community day.

Staff were very positive about working in the home and praised the teamwork and supportive atmosphere