Redesdale Court

Redesdale Court is a residential care home which provides nursing and personal care to up to 53 older people, including people living with dementia. 52 people were receiving care at the time of our inspection. One of the units of the home is an NHS consultant led facility where people are accommodated on a short-term basis for respite and rehabilitation care, usually following a hospital stay.

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

Staff were extremely caring. People and relatives were able to give numerous examples about how staff went “above and beyond" to meet people's needs. People were valued. Staff were highly motivated and committed; they appreciated people’s individual skills, attributes and personalities. They encouraged people’s independence and celebrated their achievements.

People, relatives and staff were clearly very proud of the home. Feedback about the home was consistently positive. We heard from a number of people and relatives how lucky they felt to have found the home. People, relatives and staff were invested in the home. They told us how well the service was delivered and how involved they were in running the service.

The service’s vision and values were person-centred to make sure people were at the heart of the service. This vision was driven by the exceptional leadership and high standards of the provider and manager. Robust systems to monitor the service were in place so the provider could be assured that people were receiving high quality care. The manager was committed to empowering staff. The service had excellent links with the local community and used these to enhance the lives of the people who used the service.

There was lots for people to do. There was a program of activities inside and outside of the home and people could take part in independent crafts whenever they wanted to. Staff had found professional companies to provide reminiscence activities based on people’s personal histories and the local area.

People told us they felt safe. The home was well maintained. There were enough staff to meet people’s needs and medicines were well managed. The home was clean.

Staff were well trained for their role. People’s care was planned and delivered to meet their individual needs. The home was well designed to enable people to be as independent as possible.

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

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

Rating at last inspection

At the last inspection the service was rated outstanding (published 17 August 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on the 5 and 6 May 2016 and was unannounced. The inspection team consisted of one inspector.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since November 2014. 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 culture within the home was very positive and the atmosphere warm and welcoming to all who entered. People and their relatives described the service as "fantastic", "fabulous", "brilliant" and "second to none". Staff told us that morale was very good amongst the staff team, they felt valued, completely supported by the manager who was very proactive, and they enjoyed coming to work. The vision and values of the service were person centred and the manager had a clear idea of how she wanted the service to develop. Community links were evident and the manager said she wanted everybody to be part of the home. She had arranged for external organisations to deliver dementia awareness sessions to people and their relatives and she had put herself forward to be an iCare Ambassador as part of a project run by the Skills for Care workforce strategic body, designed to promote working in the care sector in schools, colleges and jobcentres.

The provider had reward schemes and recognition awards in place to recognise staff contributions to the organisation and in addition, they offered members of staff by nomination, the opportunity of long weekend breaks in a chalet they had built in a forest retreat. This service was also offered to families of disabled children in the local community. The manager had won an internal provider award this year for innovation within the service.

There was a determination to succeed and a drive for improvement throughout the service led by the manager. Action plans were used to monitor that tasks were completed following auditing and matrices were used to track when specific documentation and training had to be renewed. The provider had also invested in a new electronic portal where the manager inputted information that could then be monitored and reviewed at a senior management level. The manager and operations manager told us that eventually some paper audits would transfer to being completed electronically on the portal. The quality assurance and governance of the service was very thorough and successful in identifying any matters that needed to be addressed.

Staff and people enjoyed excellent relationships and people were at the heart of the service. We observed staff positively encouraged and praised people when they contributed to their care and carried out tasks independently. People were treated with dignity and respect at all times and a dignity champion was in place within the home to promote dignity matters. People were actively encouraged to be involved in the service and the manager and provider had introduced innovative initiatives which empowered people to voice their opinions. These included a committee run by relatives and residents and relatives being part of the interviewing panel during interviews of potential new staff where they were also involved in designing interview questions. The caring culture of the service was demonstrated by the manager introducing memory files for people and their relatives to treasure and the implementation of the "3 wishes" project where each person selected three wishes they would like to fulfil and the service aimed to make these wishes a reality. The manager ensured that the "3 wishes" project was implemented by asking the activities coordinator to report back to her about this on a weekly basis.

People and their relatives were extremely complimentary about the service and the staff who supported them. People told us they felt safe and "at home" living at the service. Staff were aware of their responsibilities to report incidents of a safeguarding nature and they had received training in safeguarding vulnerable adults. Risks that people had been exposed to in their daily lives and within the environment of the home had been assessed and mitigated against. Accidents and incidents were monitored, analysed and measures were put in place to prevent repeat events.

Recruitment procedures were robust and medicines were managed safely and appropriately in line with best practice guidance. Staffing levels were sufficient on the days that we visited the home to meet people's needs. People told us that if they called for assistance staff attended promptly to meet their needs. Staff were trained in key areas relevant to their role and also in areas such as tissue viability, relevant to the needs of the people that they supported. There was a thorough induction package in place and supervisions and appraisals took place regularly to provide support to the staff team.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and that they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken and records about such decision making were maintained.

People were supported to eat and drink in sufficient amounts to remain healthy. There were monitoring tools in place which ensured that where there were changes in people's health and wellbeing this was identified and actions were taken to prevent any deterioration in people's conditions. For example, food and fluid charts and positional change charts were used where people were at risk of malnutrition and pressure damage. Care was person centred and care plans were regularly updated and reviewed as people's needs changed.

There was a wide range of activities available for people to partake in should they so wish and this included any trips out within the local community and further afield. People told us they had choices in abundance and we observed this during our visit. Complaints were handled appropriately and there were very few formal complaints as the manager was proactive in dealing with concerns and complaints before they escalated.

We considered all the evidence we had gathered under the regulations 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. The summary is based on our observations during the inspection, speaking with people who used the service, staff supporting them and from looking at records.

In this report the name of a registered manager appears (Mrs Elizabeth Martina Dixon) who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they were still a registered manager on our register at that time.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example by assisting them with mobility or eating. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "."They are looking after me great here. This is the best place. They are lovely and the staff are fantastic. You couldn't get better to be honest. It is like a hotel!"

People's diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Staff were fully aware of people's care and support needs.

People told us and staff confirmed they pursued activities within the home and that the activities co-ordinator endeavoured to take people out into the community regularly. This showed the provider promoted people's well-being.

Is the service responsive?

People's care needs and any potential risks that they may be exposed to were assessed before they received care and support from the provider. The provider had arrangements in place to review people's care records regularly and we saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as occupational therapists or doctors, or where, for example, their weight or behaviours needed to be monitored, they received this care.

There was an effective complaints system in place and we found that both people and staff felt confident in raising concerns with the manager. Records showed that all previous complaints raised had been handled appropriately.

Is the service safe?

We found that people were treated with respect and dignity by staff. People told us they felt safe and the care that we observed was delivered safely. For example, we saw that appropriate and safe moving and handling techniques were used when staff assisted people with mobility. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained as safe as possible in light of these identified risks.

We reviewed the arrangements in place for the management of medicines including how medicines were obtained, stored, administered and disposed of when no longer required. We found that these arrangements were both appropriate and safe. Staff were trained in the safe handling and administration of medication.

We found the building was well maintained and entry into the building was secure. People were accommodated in a safe environment which was adequately designed for safe and effective care delivery. Comprehensive health and safety checks were carried out regularly, to ensure that people, staff and visitors remained safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The manager confirmed they had been in contact with their local safeguarding team in light of this judgement, for further advice on their responsibilities and the arrangements they now need to put in place, for people in their care.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "I like how pleasant it is here and the staff are very good." Another person told us, "All the staff are very, very good." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

People's needs had been taken into account in the layout of the service and the use of pictorial and written signage, which enabled people to move around freely and safely.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. A district nurse that we spoke with told us they had no concerns about the care delivered by the provider.

An effective quality assurance system was in place which helped to ensure that people received a good quality service at all times, by monitoring care and addressing shortfalls promptly. The provider monitored the care that staff delivered and gathered the views of people and their relatives about the service they received.

Staff told us they were clear about their roles and responsibilities and they had a good understanding of the ethos of the home. The provider had a range of policies and procedures in place which gave direction and instruction to staff. Staff and resident meetings were held monthly and a number of audits were carried out regularly, in addition to health and safety checks.

People told us their consent was gained prior to care being delivered and we found that staff acted in accordance with their wishes. Where appropriate we found the provider acted in accordance with legal requirements where people did not have the capacity to give consent themselves. People told us, "Staff always ask before helping" and "I feel I make my own decisions."

We found people's care and support needs were appropriately assessed and their care was planned. They received care safely and to an appropriate standard. People told us, "I enjoy my day, there is always something to do" and "I know if I don't feel well the staff will quickly get the doctor."

People were cared for in a clean and hygienic environment and we found the service had appropriate measures in place to monitor and manage infection control. One person said, "My room is spotless, the whole place is."

Staff recruitment procedures were followed and appropriate checks were undertaken before staff began work.

We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager. People told us, "They always listen" and "My concerns are always acted upon."

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. People told us they had confidence in the service, comments included, 'It is a lovely place to live", "Staff are always there when you need them", "I like it here" and "I have no complaints at all."

People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "There is always something to do" and "Lovely place with lovely people to help you."

People told us their home was clean, comfortable and warm. They said, "This is my room, isn't it nice and I have my own bits and bobs." They said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.