Manor Court 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 care home accommodates up to 24 people in one adapted building. Nineteen people were living at the home at the time of our inspection visit. Since our previous inspection in February 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.
The service is provided by a charitable trust, Swinnerton Trust Ltd, which was first established in 1951 to provide support for older people who live in the local area. The Trust purchased the property, Manor Court Home, in 1952, refurbished it and converted it into a care home, to fulfil the aims of the charity.
The Chairman of the Board of Trustees had been appointed in 2014, but was not appointed as the Nominated Individual’ (NI) or representative for the provider, at the time of our previous inspection. In October 2017, since our previous inspection, the Chairman had been appointed as the Nominated Individual, that is, the person we communicate with about the service. During our inspection, the Chairman represented the Board of Trustees. We refer to the Chairman as ‘the provider’ in our report, but legal responsibility for the service is shared jointly by the whole Board of Trustees.
At the last inspection in February 2016, the service was rated Good. At this inspection we found improvements were required in the management, leadership and governance of the service, which also had an impact on the safety and responsiveness of the service and the overall rating.
There was not 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.
The previous registered manager had left the service in September 2016. The provider had appointed the deputy manager as the manager, and relied on the manager to take over the responsibilities of a registered manager. The provider had invited the deputy manager to apply to become the registered manager, but they had not successfully submitted an application to become registered. We refer to the deputy who was managing the service as ‘the manager’ throughout our report. Because there is no registered manager at the service, all oversights and omissions are the responsibility of the provider that is, the Board of Trustees
The provider did not demonstrate knowledge of the Health and Social Care Act Regulations 2008, but had relied on the manager to know how the Regulations applied to the service. The provider had not given the manager sufficient access to training in the requirements of being a registered person. The provider had not given the manager sufficient support, guidance or mentoring to equip them for the role of a registered manager. During our inspection visit, the manager told us they had decided not to apply to be the registered manager. They said they felt they needed more time to acquire sufficient knowledge and skills to be confident to be legally responsible for the service.
None of the Trustees of the Board had stepped in to guide, mentor or support the support the manager to understand the requirements of the delivering a registered service in accordance with the Regulations. They had not provided effective leadership for a service of this type. The systems and processes necessary to ensure good governance had not been established or operated effectively to enable improvements to the quality of the service.
Staff and the manager responded to and resolved complaints when they were raised, but there was not an effective system for recording, analysing and learning from complaints.
Improvements were required in analysing information about people’s abilities and dependencies to ensure staffing levels were reviewed and revised in line with increases in people’s needs.
Improvements were required in analysing information about accidents, incidents and falls, to ensure any risks related to the premises, staffing or staff’s skills were minimised. Improvements were required in the guidance for the manager to ensure staff recruitment was consistent in making all the necessary checks in line with best practice.
Medicines were stored, administered and managed safely, but improvements were required in the guidance for staff to ensure they followed best practice in recording when and where creams and pain relief patches were applied to people’s skin.
Work to minimise the risks related to fire safety was in progress at the time of our inspection visit. The local fire protection officer had revisited the service to check the provider was acting on their recommendations.
The provider minimised risks related to the premises and equipment through servicing agreements and regular checks by qualified professionals.
People were protected from the risks of abuse because staff were trained in recognising and reporting any safeguarding concerns. Risks to people's individual health and wellbeing were identified with the person and their representative and care was planned to minimise the identified risks.
People were cared for and supported by staff who had the skills and training to meet their needs effectively. People were supported to eat and drink enough to maintain a balanced diet that met their preferences.
People were supported to see healthcare professionals for routine appointments or when a change in their health was identified. People were supported to have 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.
Staff were thoughtful, kind and polite and had a positive attitude to their work and spoke with enthusiasm about caring for people. The manager and staff understood people's diverse needs and interests and encouraged them to maintain their independence according to their wishes and abilities. Staff respected people's right to privacy and supported people to maintain their dignity.
Staff were happy working at the home because they had confidence in their colleague’s skills and worked as a team.
Further information is in the detailed findings below.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.